Abstract
BackgroundThe aim of this study was to investigate the efficacy of etanercept treatment and to identify predictors of response to therapy within 12 months in patients with juvenile idiopathic arthritis (JIA) without systemic manifestations.MethodsA total of 197 juvenile patients were enrolled in this study. Response to therapy was assessed using the ACRPedi 30/50/70/90 criteria, the Wallace criteria, and the Juvenile Arthritis Disease Activity Score 71 (JADAS-71). Univariate and multivariate logistic regression analyses were performed to identify potential baseline factors associated with treatment response in different JIA categories.ResultsOne year after treatment initiation, 179 (90.9%) patients achieved ACRPedi30; 177 (89.8%) patients achieved ACRPedi50; 168 (85.3%) patients achieved ACRPedi70; and 135 (68.5%) patients achieved ACRPedi90 response. A total of 132 (67.0%) and 92 (46.7%) patients achieved inactive disease according to the Wallace criteria and the JADAS-71 cut-off point, respectively. Excellent response (achieving ACRPedi90 and clinically inactive disease according both to the Wallace criteria and the JADAS71 cut-off point) was associated with persistent oligoarticular JIA category, shorter disease duration before the start of etanercept, a lower number of DMARDs used before the introduction of etanercept, a lower number of joints with limited motion, and lower C-reactive protein at baseline. Poor response (failure to achieve ACR 70 or active disease according to both the Wallace criteria and JADAS71 even when ACR 70 was achieved) was associated with the polyarticular or enthesitis-related JIA categories, higher disease duration before the start of etanercept, and older age at disease onset.ConclusionAlmost half (45.7%) of the patients who initiated etanercept treatment achieved an excellent response (inactive disease and ACRPedi90) after 1 year. What may be novel is our finding that the response to etanercept therapy was strongly associated with the JIA category. The response to etanercept therapy was also associated with the disease duration before the start of etanercept treatment.
Highlights
The aim of this study was to investigate the efficacy of etanercept treatment and to identify predictors of response to therapy within 12 months in patients with juvenile idiopathic arthritis (JIA) without systemic manifestations
The efficacy of etanercept, a TNFα inhibitor, in daily practice for JIA was confirmed in controlled clinical trials where at least 70% of patients in all categories except RF-positive polyarthritis achieved ACR Pedi 30 and at least 40% of patients in all categories achieved ACR70 [6,7,8]; Childhood Health Assessment Questionnaire (CHAQ) scores decreased in approximately 53% of patients after 12 weeks of treatment [9], and 41.8% of patients receiving long-term therapy with etanercept achieved inactive disease according to the Wallace criteria [10]
Factors associated with treatment response according to JIA categories The following potential baseline predictors of response to etanercept treatment were selected based on the literature data: demographic indicators, indicators of disease activity, previous therapy, background therapy, and laboratory tests (ESR, C-reactive protein (CRP))
Summary
The aim of this study was to investigate the efficacy of etanercept treatment and to identify predictors of response to therapy within 12 months in patients with juvenile idiopathic arthritis (JIA) without systemic manifestations. CHAQ child health assessment questionnaire, CI confidence interval, DMARD disease-modifying antirheumatic drug, ESR erythrocyte sedimentation rate, JIA juvenile idiopathic arthritis, VAS visual analog scale All entries in italic are statistically significant two children without a history of uveitis developed it after 6 months of etanercept use. The total rate of uveitis or uveitis flares was 3 cases (1.5%) within the first year of treatment: one case using monotherapy and two cases using combination therapy with methotrexate This rate is somewhat lower than the data reported by other authors, the large cohort of children from the Italian Registry) [10, 21], which could be due to both population features and differences in the total cohort of patients with respect to age and JIA category. The CHAQ score was significant in the univariate analysis for the polyarticular RF-negative group in the poor response model but was insignificant in the multivariate analysis
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