Abstract
BackgroundAnti-tumor necrosis factor (TNF) drugs have improved the prognosis for juvenile idiopathic arthritis (JIA) significantly. However, evidence for individual treatment decisions based on serum anti-TNF drug levels and the presence of anti-drug antibodies (ADAbs) in children is scarce. We aimed to assess if anti-TNF drug levels and/or ADAbs influenced physician’s treatment decisions in children with JIA.MethodsPatients’ records in our center were retrospectively screened for measurements of anti-TNF drug levels and ADAbs in children with JIA using etanercept, adalimumab or infliximab. Clinical characteristics and disease activity were retrieved from patient charts.ResultsWe analyzed 142 measurements of anti-TNF drug levels in 65 children with JIA. Of these, ninety-seven (68.3%) were trough concentrations. N = 14/97 (14.4%) of these showed trough concentrations within the therapeutic drug range known for adults with RA and IBD. ADAbs against adalimumab were detected in seven patients and against infliximab in one patient. Seven (87,5%) of these ADAb-positive patients had non-detectable drug levels. A flowchart was made on decisions including rational dose escalation, stopping treatment in the presence of ADAbs and undetectable drug levels, showing that 45% of measurements influenced treatment decisions, which concerned 65% of patients (n = 42/65).ConclusionsIn the majority of patients, measurement of anti-TNF drug levels led to changes in treatment. A wide variation of anti-TNF drug levels was found possibly due to differences in drug clearance in different age groups. There is need for determination of therapeutic drug ranges and pharmacokinetic curves for anti-TNF and other biologics in children with JIA.
Highlights
Anti-tumor necrosis factor (TNF) drugs have improved the prognosis for juvenile idiopathic arthritis (JIA) significantly
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by idiopathic chronic joint inflammation that persists for longer than 6 weeks, and has a disease onset before the age of 16 years
We conducted a retrospective study in children under the age of 18 years with a diagnosis of JIA fitting the ILAR criteria [28] that were treated with etanercept (Enbrel®), adalimumab (Humira®) and/or infliximab (Remicade®, Remsima®, Inflectra®) in our center
Summary
Anti-tumor necrosis factor (TNF) drugs have improved the prognosis for juvenile idiopathic arthritis (JIA) significantly. Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by idiopathic chronic joint inflammation that persists for longer than 6 weeks, and has a disease onset before the age of 16 years. It is the most prevalent rheumatic disease in childhood [1]. Biologics that are currently being used in JIA include anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab and certolizumab pegol) This has changed the pediatric rheumatology landscape substantially, but improvements in the use of anti-TNF drugs are still needed, especially since anti-TNF drugs will be used earlier in the disease course when following recent international adaptations of JIA treat-to-target strategies [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
