Long Term Safety and Efficacy of Etanercept in Juvenile Idiopathic Arthritis in a Single Center

Myung Hoon Bang; Kwang Nam Kim

doi:10.4078/jrd.2019.26.3.200

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Bang and Kim: Long Term Safety and Efficacy of Etanercept in Juvenile Idiopathic Arthritis in a Single Center

Original Article

J Rheum Dis 2019;26(3):200-205.

Published online: 31 October 2019

DOI: https://doi.org/10.4078/jrd.2019.26.3.200

Long Term Safety and Efficacy of Etanercept in Juvenile Idiopathic Arthritis in a Single Center

Myung Hoon Bang, Kwang Nam Kim

Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea

Corresponding to: Kwang Nam Kim http://orcid.org/0000-0003-4024-5128 Department of Pediatrics, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea. E-mail: kwangnamkim@naver.com

Received 4 March 201917 May 2019 Accepted 3 June 2019

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Our aim was to investigate the long term safety and efficacy of etanercept in children with juvenile idiopathic arthritis (JIA).

Methods

The study subjects were the 90 JIA patients treated with etanercept in the Department of Pediatrics, Hallym University Medical Center between January 2004 and December 2017. We retrospectively reviewed their medical records for age at diagnosis, duration of etanercept treatment, number of active joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and adverse events during treatment.

Results

Among the 90 patients, 38 (42.0%) were male and 52 (58.0%) were female; 15 (16.7%) had systemic onset, 41 (45.6%) had extended oligoarticular, 14 (15.6%) had rheumatoid factor-positive polyarticular, 18 (20.0%) had rheumatoid factor-negative polyarticular, and 2 (2.1%) had enthesitis-related arthritis. The median age at the start of etanercept treatment was 9 years (range, 3∼18 years), and the median duration of etanercept treatment was 6 years (range, 0.5∼13 years). The median number of active joints decreased from 9 to 0 after 6 months of etanercept treatment. The median CRP and ESR were within normal range after 3 months of treatment. Six patients experienced recurrence, 9 switched to other medications and 3 discontinued etanercept. Of the 14 reported adverse events, 1 was serious, and there were no tuberculosis infections or malignancies.

Conclusion

Long-term treatment with etanercept is efficacious and safe for children with JIA. However, those with the systemic onset subtype appear to have low drug survival rate compared to those with other types of JIA.

Keywords: Juvenile idiopathic arthritis, Etanercept

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Figure 1.

Drug survival of etanercept. RF: rheumatoid factor. *p<0.01.

Table 1.

Clinical characteristics of patients treated by etanercept

Characteristics	All patients (n=90)
Female	52 (58.0)
Age at start of etanercept (yr)	9 (3∼18)
Disease duration before etanercept (yr)	5.5 (0∼13)
Duration of etanercept therapy (yr)	6 (0.5∼13)
JIA onset type
Systemic onset arthritis	15 (16.7)
Extended oligoarthritis	41 (45.6)
RF-positive polyarthritis	14 (15.6)
RF-negative polyarthritis	18 (20.0)
Enthesitis-related arthritis	2 (2.1)
DMARD before etanercept treatment
Methotrexate	84
Hydrochloroquine	77
Sulfasalazine	7

Values are presented as number (%) or median (range). JIA: juvenile idiopathic arthritis, RF: rheumatoid factor, DMARD: disease-modifying antirheumatic drug.

Table 2.

Duration of etanercept treatment

Duration	Number of total patients	Medication switching	Medication discontinuation
6 mo∼1 yr	8	2	0
1∼2 yr	6	1	0
2∼3 yr	13	3	0
3∼4 yr	8	2	0
4∼5 yr	6	0	0
5∼6 yr	4	0	1
6∼7 yr	5	1	0
7∼8 yr	9	0	1
8∼9 yr	5	0	0
9∼10 yr	8	0	0
10∼11 yr	7	0	0
11∼12 yr	3	0	1
12∼13 yr	5	0	0
13∼14 yr	3	0	0
Total	90	9	3

Table 3.

Number of patients, active joints, CRP, and ESR levels at baseline and follow-up periods

Patients	Follow-up period
Patients	Baseline	3 mo	6 mo	1 yr	5 yr	10 yr
All patients	n=90	n=90	n=90	n=82	n=49	n=18
No. of active joints	9 (5∼24)	2 (0∼26)	0 (0∼11)	0 (0∼4)	0 (0∼3)	0 (0∼2)
CRP	22.4 (0.5∼180.0)	1.8 (0.5∼157.0)	1.6 (0.5∼79.0)	1.5 (0.5∼67.2)	1.5 (0.5∼24.7)	1.1 (0.5∼15.1)
ESR	43 (2∼130)	12 (1∼80)	12 (2∼65)	11 (2∼65)	11 (2∼59)	9 (2∼48)
Systemic onset	n=15	n=15	n=15	n=13	n=10	n=2
No. of active joints	13 (5∼24)	3 (0∼10)	0 (0∼11)	0 (0∼4)	0 (0∼1)	0 (0)
CRP	82.2 (0.5∼180.0)	3.6 (0.5∼103.0)	3.5 (1.0∼79.0)	1.6 (0.6∼67.2)	1.5 (0.5∼24.7)	1.2 (1.2)
ESR	69 (2∼130)	21 (2∼58)	15 (4∼57)	13 (2∼50)	9 (4∼58)	4 (4)
Extended oligoarthritis	n=41	n=41	n=41	n=39	n=21	n=10
No. of active joints	8 (5∼14)	2 (0∼26)	0 (0∼3)	0 (0∼2)	0 (0∼1)	0 (0∼1)
CRP	26.7 (0.5∼130.0)	1.2 (0.5∼47.7)	1.1 (0.5∼36.9)	1.5 (0.5∼13.9)	1.5 (0.5∼12.9)	1.2 (0.5∼5.0)
ESR	45 (6∼120)	12 (1∼55)	9 (2∼65)	9 (2∼59)	10 (5∼14)	10 (5∼14)
RF(+) polyarthritis	n=14	n=14	n=14	n=11	n=8	n=4
No. of active joints	17 (6∼22)	4 (0∼14)	1 (0∼3)	0 (0∼2)	0 (0∼3)	0 (0∼2)
CRP	14.1 (2.3∼46.7)	2.4 (0.5∼13.2)	2.3 (0.5∼62.2)	1.1 (0.5∼8.5)	2.1 (0.5∼4.5)	1.1 (0.5∼15.1)
ESR	32 (11∼89)	9 (3∼49)	13 (4∼43)	10 (3∼23)	9 (4∼33)	5 (2∼48)
RF(−) polyarthritis	n=18	n=18	n=18	n=17	n=8	n=2
No. of active joints	11 (7∼24)	3 (0∼24)	0 (0∼3)	0 (0∼2)	0 (0)	0 (0)
CRP	8.8 (0.5∼64.3)	1.6 (0.5∼15.7)	1.7 (0.5∼15.6)	2.1 (0.5∼9.7	1.0 (0.5∼5.0)	0.5 (0.5)
ESR	33 (2∼87)	11 (2∼80)	13 (2∼51)	14 (3∼21)	16 (6∼28)	9 (9)
ERA	n=2	n=2	n=2	n=2	n=2
No. of active joints	7 (5∼8)	0 (0)	0 (0)	1 (0∼1)	1 (0∼1)
CRP	48.5 (2.7∼94.3)	1.9 (1.2∼2.7)	2.0 (1.2∼2.7)	6.5 (3.4∼9.6)	10.7 (9.7∼10.7)
ESR	56 (10∼102)	7 (3∼10)	8 (6∼10)	15 (10∼20)	33 (24∼33)

Values are presented as median (range). CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, RF(+): rheumatoid factor positive, RF(−): rheumatoid factor negative, ERA: enthesitis-related arthritis.

Table 4.

Reasons for switching medication or discontinuing etanercept

Reasons	Number (%)
Reasons for switching medication
Recurrent or severe uveitis
Adalimumab (Humira)	3 (3.3)
Lack of efficacy
Adalimumab (Humira)	2 (2.2)
Abatacept (Orencia)	3 (3.3)
Tocilizumab (Actemra)	1 (1.1)
Reasons for discontinuing
Satisfactory result	3 (3.3)

Table 5.

Adverse events

Adverse events	Number (%)
Non-serious adverse event
Localized pain of injection site	6 (6.7)
Dysmenorrhea	2 (2.2)
Serious adverse event
Uveitis	5 (5.6)
Recurrent cellulitis	1 (1.1)
Tuberculosis	0
Malignancy	0

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