OP0306 ETANERCEPT AND ADALIMUMAB IN THE TREATMENT OF JUVENILE PSORIATIC ARTHRITIS

Abstract

Background:Juvenile psoriatic arthritis (JPsA) accounts for 4 to 9% of children with juvenile arthritis (1). Biologics, particularly TNF-α inhibitors, have proved to be effective and safe for treatment of psoriatic arthritis in adults (2). However, no comprehensive evidence exists on the comparative effectiveness and safety of TNF-α inhibitors in the treatment of JPsA, which challenges a decision of what biologic should be prescribed to children with JPsA.Objectives:To study the comparative effectiveness of etanercept and adalimumab in patients with JPsA with respect to both the articular and skin manifestations.Methods:Our observational (2012-2019), parallel-group, open-label, single-centre cohort clinical study involved 34 patients (2-13 y/o) with JPsA who met Vancouver and I/E criteria and received etanercept SC (0.8 mg/kg QW, max 50 mg per week) or adalimumab SC (max 40 mg Q2W), both in combination with methotrexate (10-15 mg/m2 QW). Intention-to-treat analysis was used to evaluate treatment efficacy at months 6, 12, and 18 after biologic therapy initiation. To assess articular manifestations of JPsA, we applied ACRpedi criteria; to estimate the surface area of involved skin and severity of psoriasis – the PASI score.Results:We observed 34 patients with JPsA (2 to 13 y/o), who were initiated by biological therapy (etanercept [n=18 - group 1] and adalimumab [n=16 - group 2]) (Table 1, Figure 1).Table 1.Clinical and demographic characteristics of patients with JPsA before biologic therapy initiation (n=34)clinical and demographic indicatorsGroup 1(Etanercept)M±δ / Me (Q1-Q3)Group 2(Adalimumab)M±δ / Me (Q1-Q3)Girl/Boy Ratio12:6 (2:1)10:6 (1,7:1)Average age, years7,58 ± 3,75,8 ± 3Duration of the disease, years3,0 (1,4-6,6)3,5 ± 2Uveitis (n, %)05 (31,3%)ANA positivity (n, %)2 (11%)8 (50%)RF positivity (%)00No. active joints8,0 (5-16,5)5,5 (3-8,5)No. joints with LOM9(5,75-18,25)6 (3,5-10,5)PGA of disease activity, mm70 ± 1565,9 ± 12,7Parent’s global assessment of the child’s pain, VAS71,5 (65-90)72,5 ± 14СНАQ1,34 (1,1-1,68)1,25 (0,93-1,44)Psoriasis BSA, %7,0 (4-13)8 (3-13) PASI score5,7 (3-8,2)9 (5-19)ESR, mm/h28 (20,75-40)24,5 (21-32)ANA - antinuclear antibodies, RF - rheumatoid factor, LOM - limitation of motion, PGA - physician’s global assessment; VAS - visual analog scale, CHAQ - Childhood Health Assessment Questionnaire; BSA - body surface area; PASI - Psoriasis Area Severity Index, ESR - erythrocyte sedimentation rate; CRP - C-reactive protein.Figure 1.Comparative efficacy of etanercept and adalimumab in children with JPsA, according to the ACRpedi criteria at months 6, 12, and 18 after treatment initiation. No statistically significant difference in the efficacy of etanercept and adalimumab in patients with juvenile psoriatic arthritis was obtained, according to the ACRpedi criteria. The efficacy of biologic treatment on skin manifestations of JPsA was also evaluated (Figure 2).Figure 2.Comparative efficacy of etanercept and adalimumab in children with JPsA by PASI score at months 6, 12, and 18 after treatment initiation. Both TNF-α blockers (etanercept, adalimumab) showed similar efficacy for psoriasis in patients with JPsA, though response rate for psoriasis in adalimumab group was higher than in etanercept group.Conclusion:Both TNF-α inhibitors (etanercept and adalimumab) proved to be effective in the treatment of arthritis and psoriasis in JPsA. There was no statistically significant difference in the effectiveness of etanercept and adalimumab in the treatment of JPsA in our cohort. Both biological agents can be successfully used to treat JPsA.