OP0306 ETANERCEPT AND ADALIMUMAB IN THE TREATMENT OF JUVENILE PSORIATIC ARTHRITIS
Authors: K. Aleksanyan, S. Chebysheva, O. Sukhovyova, E. Zholobova
Journal: Annals of the Rheumatic Diseases (2021)

Background: Juvenile psoriatic arthritis (JPsA) accounts for 4 to 9% of children with juvenile arthritis (1). Biologics, particularly TNF-α inhibitors, have proved to be effective and safe for treatment of psoriatic arthritis in adults (2). However, no comprehensive evidence exists on the comparative effectiveness and safety of TNF-α inhibitors in the treatment of JPsA, which challenges a decision of what biologic should be prescribed to children with JPsA. Objectives: To study the comparative effectiveness of etanercept and adalimumab in patients with JPsA with respect to both the articular and skin manifestations. Methods: Our observational (2012-2019), parallel-group, open-label, single-centre cohort clinical study involved 34 patients (2-13 y/o) with JPsA who met Vancouver and I/E criteria and received etanercept SC (0.8 mg/kg QW, max 50 mg per week) or adalimumab SC (max 40 mg Q2W), both in combination with methotrexate (10-15 mg/m 2 QW). Intention-to-treat analysis was used to evaluate treatment efficacy at months 6, 12, and 18 after biologic therapy initiation. To assess articular manifestations of JPsA, we applied ACRpedi criteria; to estimate the surface area of involved skin and severity of psoriasis – the PASI score. Results: We observed 34 patients with JPsA (2 to 13 y/o), who were initiated by biological therapy (etanercept [n=18 - group 1] and adalimumab [n=16 - group 2]) (Table 1, Figure 1). Table 1. Clinical and demographic characteristics of patients with JPsA before biologic therapy initiation (n=34) clinical and demographic indicators Group 1 (Etanercept ) M±δ / Me (Q1-Q3 ) Group 2 (Adalimumab ) M±δ / Me (Q1-Q3 ) Girl/Boy Ratio 12:6 (2:1) 10:6 (1,7:1) Average age, years 7,58 ± 3,7 5,8 ± 3 Duration of the disease, years 3,0 (1,4-6,6) 3,5 ± 2 Uveitis (n, %) 0 5 (31,3%) ANA positivity (n, %) 2 (11%) 8 (50%) RF positivity (%) 0 0 No. active joints 8,0 (5-16,5) 5,5 (3-8,5) No. joints with LOM 9(5,75-18,25) 6 (3,5-10,5) PGA of disease activity, mm 70 ± 15 65,9 ± 12,7 Parent’s global assessment of the child’s pain, VAS 71,5 (65-90) 72,5 ± 14 СНАQ 1,34 (1,1-1,68) 1,25 (0,93-1,44) Psoriasis BSA, % 7,0 (4-13) 8 (3-13) PASI score 5,7 (3-8,2) 9 (5-19) ESR, mm/h 28 (20,75-40) 24,5 (21-32) ANA - antinuclear antibodies, RF - rheumatoid factor, LOM - limitation of motion, PGA - physician’s global assessment; VAS - visual analog scale, CHAQ - Childhood Health Assessment Questionnaire; BSA - body surface area; PASI - Psoriasis Area Severity Index, ESR - erythrocyte sedimentation rate; CRP - C-reactive protein. Figure 1. Comparative efficacy of etanercept and adalimumab in children with JPsA, according to the ACRpedi criteria at months 6, 12, and 18 after treatment initiation. No statistically significant difference in the efficacy of etanercept and adalimumab in patients with juvenile psoriatic arthritis was obtained, according to the ACRpedi criteria. The efficacy of biologic treatment on skin manifestations of JPsA was also evaluated (Figure 2). Figure 2. Comparative efficacy of etanercept and adalimumab in children with JPsA by PASI score at months 6, 12, and 18 after treatment initiation. Both TNF-α blockers (etanercept, adalimumab) showed similar efficacy for psoriasis in patients with JPsA, though response rate for psoriasis in adalimumab group was higher than in etanercept group. Conclusion: Both TNF-α inhibitors (etanercept and adalimumab) proved to be effective in the treatment of arthritis and psoriasis in JPsA. There was no statistically significant difference in the effectiveness of etanercept and adalimumab in the treatment of JPsA in our cohort. Both biological agents can be successfully used to treat JPsA. References: [1]Beukelman T., et al. The new Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry: design, rationale, and characteristics of patients enrolled in the first 12 months. PediatrRheumatol Online J. 2017;15(1):30 [2]Ruyssen-Witrand A., et al. Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis. RMD Open. 2020;6(1):е001117 Disclosure of Interests: Karina Aleksanyan: None declared, Svetlana Chebysheva: None declared, Olga Sukhovyova: None declared, Elena Zholobova Speakers bureau: Pfizer, AbbVie, Novartis, Roche.