Introduction Of Etanercept Research Articles

Predictors of the response to etanercept in patients with juvenile idiopathic arthritis without systemic manifestations within 12 months: results of an open-label, prospective study conducted at the National Scientific and Practical Center of Children's Health, Russia

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.

MANAGEMENT OF PSORIATIC ARTHRITIS IN CHILDREN

Psoriatic arthritis affects 15% of children with chronic rheumatic joint disease. Aim of the study. To evaluate articular prognosis in 9 children (6-16 years) diagnosed with psoriatic arthritis and treated with different therapeutic agents, related to the degree severity of the cutaneous involvement. Results. Sex ratio in the study group was girls/boys = 3/6. 1st degree relatives with psoriasis were found in 5/9 cases. Poliarticular juvenile arthritis with multiple localizations (small distal hand and feet joints, radiocarpal, tibiotarsian joints) were found in 6 cases; the other 3 patients had extensive oligoarthritis (no identified HLA B27 association). None of the patients had ankyloses or severe functional motor deficiency. PASI score <10 was found in 4 children. Specific therapy consisted of methotrexate (2 patients) and association between methotrexate and etanercept (7 patients); All 9 children received local topical therapy. After 6-month treatment, the evaluation of patients who have received methotrexate associated with etanercept found ACR Pedi 30 response in 4 children and ACR Pedi 50 in 3 cases; PASI score was lower than 10 in 5 of these children. The 2 patients under methotrexate monotherapy showed neither ACR Pedi 30 response, nor improvement of the cutaneous symptoms after 6 months of treatment, so etanercept was added to methotrexate. The 12-month evaluation showed ACR Pedi 30 response in all 9 children; ACR Pedi 50 response in 6 children; PASI < 10 in 7 children. Conclusions. Early introduction of etanercept in addition to methotrexate seems to improve the prognosis of psoriatic arthritis, as well as skin disease, aspects that clearly ensure optimization of the quality of life of these patients.

New treatments for inflammatory rheumatic disease.

As our understanding of the pathogenesis of autoimmune diseases is growing, new therapies are being developed to target disease-specific pathways. Since the introduction of etanercept in 1998, several biotechnological agents have been developed, most of them indicated in the treatment of rheumatoid arthritis, but also psoriatic arthritis. Most currently available molecules target TNF-alfa with different strategies (i.e., etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol), IL-6 (tocilizumab), CTLA-4 (abatacept), and B cells (rituximab, belimumab) as they are key mediators in the cascade of inflammation. Further, small molecules have been recently developed to target intracellular signaling, such as Janus Kinases for tofacitinib, the first FDA-approved small molecule for rheumatoid arthritis. Most novel treatments are being developed for arthritis with specific differences between rheumatoid and psoriatic arthritis, as well as for systemic lupus erythematosus, following the approval of belimumab. Finally, biologic therapies are effective also in gout, mainly targeting interleukin-1 to block the inflammasome. This review article describes the new and upcoming treatment options for rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and gout to dissect what we should be aware of when discussing these new and promising molecules.

Etanercept: A Review of Its Use in Autoimmune Inflammatory Diseases

With its approval more than 15 years ago, subcutaneous etanercept (Enbrel(®)) was the first biological disease-modifying antirheumatic drug (bDMARD) and the first tumour necrosis factor inhibitor to be approved for use in rheumatic diseases. Etanercept remains an important cost-effective treatment option in adult patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or plaque psoriasis, and in paediatric patients with juvenile idiopathic arthritis or plaque psoriasis. In all of these populations, etanercept (with or without methotrexate) effectively reduced signs and symptoms, disease activity and disability, and improved health-related quality of life, with these benefits sustained during long-term treatment. The safety profile of etanercept during short- and long-term treatment was consistent with the approved product labelling, with adverse events being of a predictable and manageable nature. The introduction of etanercept and other bDMARDs as therapeutic options for patients with autoimmune rheumatic diseases and spondyloarthropathies revolutionized disease management and these agents continue to have a central role in treatment strategies. This article reviews the extensive clinical experience with etanercept in these patient populations.

FRI0279 Follow-Up Investigation of Efficacy/Safety of Etanercept in Patients Who Successfully Became Pregnant after Its Introduction

BackgroundHigh activity levels of rheumatoid arthritis (RA) may lead to reduced fertility or further deterioration of the disease after pregnancy. Therefore, it is important for patients with RA to become...

FRI0354 Effectiveness and safety of a second and third biological agent after failing etanercept in juvenile idiopathic arthritis; results from the dutch national ABC register

BackgroundDespite the treatment successes of etanercept in most JIA patients, around 10-22% of previously biologically-naive JIA patients discontinued etanercept within 12 months because of a lack of effectiveness or intolerance....

FRI0432 Well-being, sleep and coping had good psychometric properties in rheumatoid arthritis (RA): A subanalysis of an etanercept trial

BackgroundIn RA, there is increasing interest in “unusual” patient-reported outcomes (PROs), over and above pain, function and fatigue; namely, quality of sleep, well-being and ability to cope [1]. Although these...

Etanercept for the treatment of axial spondyloarthritis

The introduction of etanercept (ETN; Enbrel®), and other TNF-blockers, has revolutionized the treatment of patients with ankylosing spondylitis. ETN, as with other approved TNF-blockers, shows good efficacy in treating spinal disease, especially if patients are treated early. Furthermore, studies involving ETN demonstrate good long-term efficacy. This review summarizes the data on ETN in the treatment of ankylosing spondylitis and non-radiographic axial spondyloarthritis, and discusses topics such as its efficacy in treating extra-articular manifestations, dose modifications and immunogenicity of ETN, and switching between ETN and other TNF-blockers, as well as radiographic progression and safety.

Malignancy Risks With Biologic Therapies

The management of rheumatoid arthritis (RA) dramatically changed in 1998 with the introduction of etanercept and infliximab for the treatment of RA and Crohn colitis. Nine biologic agents are currently in use for treating RA. However, speculation has grown that the long-term use of these biopharmaceuticals may alter normal immunosurveillance, thereby contributing to an individual's cancer risk. Whether malignancy is a consequence of rheumatoid inflammation or the therapies used to treat RA has been unclear until recently. This article addresses the growing data on the short- and long-term cancer risks associated with biologic use in RA.

Severe aplastic anemia in a patient with rheumatoid arthritis after introduction of etanercept

Abstract A 73-year-old female, diagnosed with rheumatoid arthritis (RA), complicated with severe levels of joint destruction, started etanercept (ETN) because of high persistent RA disease activity. Although her articular symptoms dramatically improved, she developed marked pancytopenia after the introduction of ETN. Bone marrow aspirate specimen revealed hypocellular marrow in three hematopoietic series without atypical findings, which was compatible with aplastic anemia (AA). This is a rare case of severe pancytopenia due to AA presumably induced by ETN.

Effectiveness and safety of a second and third biological agent after failing etanercept in juvenile idiopathic arthritis: results from the Dutch National ABC Register

ObjectiveTo evaluate the effectiveness and safety of switching to a second or third biological agent in juvenile idiopathic arthritis (JIA) after etanercept failure.MethodsThe Arthritis and Biologicals in Children Register aims...

Reversible Heart Failure in a Patient Receiving Etanercept for Ankylosing Spondylitis

A 42-year-old man with ankylosing spondylitis that was refractory to nonsteroidal anti-inflammatory drugs as well as various disease-modifying antirheumatic drugs was subjected to anti-TNF compounds. Administration of infliximab and adalimumab gave excellent clinical response but was discontinued due to adverse events. Introduction of etanercept was also clinically effective but followed by development of severe heart failure. Discontinuation of etanercept led to control of heart function. The unusually though potentially life-threatening possibility of heart failure secondary to anti-TNF use in ankylosing spondylitis merits attention.

Comparison of subjective and objective assessment of angina pectoris.

<h3>Objective</h3> Antitumor necrosis factor-α (anti-TNF-α) therapy is the most prescribed biologic agent therapy in rheumatology and gastroenterology. However, a number of serious side effects have been reported with these drugs. Only a handful of cases of new-onset inflammatory bowel disease (IBD), mostly in children diagnosed with juvenile idiopathic arthritis (JIA), have been reported during anti-TNF-α therapy. We present 3 cases of adult IBD following anti-TNF-α therapy and a literature review on this topic. <h3>Methods</h3> We searched PubMed MESH for all relevant terms, papers were reviewed, and patient-specific data were extracted. Relevant clinical data were calculated and presented. <h3>Results</h3> The PubMed search resulted in 137 articles, of which 11 articles and 4 cited publications were included in our analysis. We found 53 cases of IBD after anti-TNF-α therapy reported in the literature; most of them were case series collected retrospectively from national databases or studies. Almost all the patients developed IBD after the introduction of etanercept (ETN); 2 patients with rheumatoid arthritis were also included. The average age at IBD onset was 17.3 years and the average time from ETN introduction to IBD onset was 27 months (± 24). Gastrointestinal symptoms have been reported as improving or subsiding in most of the patients after discontinuing ETN. <h3>Conclusion</h3> Although this manifestation is not common, it should be taken into consideration as an adverse effect of ETN. Rheumatologists, and in particular rheumatologists treating adult patients, should be aware of this possible complication. Further investigation about the pathogenic process underlying this phenomenon is warranted.