AB0981 10-YEARS EXPERIENCE OF ETANERCEPT USE IN TREATMENT OF JUVENILE IDIOPATHIC ATRTRITIS IN CHELYABINSK REGIONAL PEDIATRIC HOSPITAL
Authors: Galina Glazyrina, Olga Sudareva
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Juvenile idiopathic arthritis (JIA) in recent decades has changed its course, thanks to the use of genetically engineered biological drugs. If therapy with methotrexane is inefficient etanercept is the drug of choice for JIA treatment. Etanercept has been used in Chelyabinsk regional pediatric hospital during 10 years. <h3>Objectives</h3> Performance and safety assessment of etanercept in patients with JIA in Chelyabinsk regional pediatric hospital. <h3>Methods</h3> 51 children aged from 3 to 17 (mean age 10,0 years) diagnosed with JIA were under monitoring (12 boys, 39 girls). Disease duration was from 2 to 15 years (mean duration 5,4 years). JIA was diagnosed based on ILAR diagnostic criteria. Oligo arthritis was diagnosed in 9 children, sero-negative polyarthritis was diagnosed in 34 children. 3 patients had systemic JIA (without active systemic presentations), 5 children had enthesitic JIA. X-ray stage 1-2 was observed in 45 children and stage 3-4 in five. Enhancement antigens HLA B 27 were found in 11 children. In all children methotrexate was ineffective in dose of 15 mg/m<sup>2</sup> during 6-12 months. Etanercept was introduced in dose of 0.8 mg QW. Therapy duration was from 3 months to 8 years (mean duration 29 months). Assessment of disease activity and therapy efficiency was conducted in accordance with ACR pedi criteria. Nonparametric statistical methods were used to compare results. <h3>Results</h3> Prior to etanercept use high disease activity was observed in all children. Mean number of joints with active arthritis was 8 [4, 10] (ME[25;75%]). Mean number of joints with functional impairments – 4 [2;10]. Mean ESR (according to Panchenkov) – 23 [10;35] mm/h, CRP 12,0 [5,7;32] g/L. Assessment of functional activity according to CHAQ questionnaire – 1,25 [1;2]. Activity assessment according to VAS by doctor – 70 [60;70]. Assessment of parents/patients according to VAS 70 [60;80]. No active systemic presentations and eye lesions were found in children under monitoring. On the background of etanercept therapy a decrease in disease activity was observed in 50 patients. Mean number of joints with active arthritis was 0 [0;2] (ME[25;75%]) (P≤0.0001). Mean number of joints with functional impairments – 0 [0;.2] (P≤0.0001). Mean ESR was 5 [3,6] mm/h (P≤0.0001), CRP 3 [2;4] g/L (P≤0.0001). Assessment of functional activity according to CHAQ questionnaire was 0,125 [0;0,5] (P≤0.0001). Activity assessment according to VAS by doctor – 10 [5;20] (P≤0.0001). Assessment of parents according to VAS 10 [5;20] (P≤0.0001). Clinical disease remission (according to ACR pedi criteria ≥90%) was observed in 32 patients after 6-12 months of treatment. Remission duration up to now is from 1 to 7 years. Efficiency according to ACR pedi criteria is 70% in 11 children, 50% in 5, 30% in 2. Etanercept was well-tolerated. Drug was cancelled in 9 patients. 6 patient (11,8%) developed bilateral uveitis, one patient had an allergic reaction (rash), one - systemic manifestations, one - urinary tract infection. There were no cases of tuberculosis. <h3>Conclusion</h3> Etanercept therapy was highly effective and safe in patients with JIA. Clinical remission was achieved in 62,7% children. Decrease in disease activity was observed in 98% of children. 11,8% patient developed uveitis, on average, after a year of using etanercept. <h3>References</h3> [1] Lovell D. J., Reiff A., Jones O. Y., Schneider R. et al. Long-term safety and efficacy of etanercept in children with polyarticular-course juvenile rheumatoid arthritis//Arthritis Rheum. 2006; 54: 1987–1994. <h3>Disclosure of Interests</h3> None declared