1) To assess the efficacy of etanercept in the treatment of children with juvenile idiopathic arthritis (JIA) after 6 months of therapy, 2) to analyse the contribution of several variables in the clinical response, and 3) to evaluate the safety and tolerability of the drug after 12 months of treatment.
Retrospective chart review of JIA patients started on etanercept from January 2000 to June 2007. The same clinical and laboratory variables were considered at the beginning of therapy and 3 and 6 months afterwards. Clinical improvement was defined according to the American College of Rheumatology pediatric criteria for improvement (ACRped).
Seventy one patients were studied. The ACRpedi30 response was achieved by 77.5% of the children, the ACRped50 by 70.4% and the ACRped70 by 54.9%. All children (100%) with enthesitis related arthritis, 91.7% of those with oligoarthritis and 66.7% with polyarthritis responded according to ACRped30. An ACRped30 response was achieved by 63% of children with systemic JIA (n=19), although fever was not controlled in any of the 12 children who presented it, and all but three required an increase in the steroid dose (oral and/or intra-articular). Etanercept was discontinued in 12 patients, 6 during the first six months and six between 7 and 12 months of therapy. In 7 of them because of inefficacy or flare-up. At the 12 month follow-up 80.3% of the patients continued taking etanercept.
Etanercept is effective for the treatment of JIA and is well tolerated by children. Its clinical usefulness is very much reduced in children with systemic JIA.