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VARIABLE RESPONSE OF SYSTEMIC JRA TO ETANERCEPT(enbrel)

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From the ACR: VARIABLE RESPONSE OF SYSTEMIC JUVENILE RHEUMATOID

ARTHRITIS TO ETANERCEPT.

Gloria C Higgins, Karla , M Rennebohm Columbus, OH

Nine patients with active systemic JRA treated with etanercept (starting

dose 0.4 mg/kg by subcutaneous injection twice weekly) were followed for

7-14 months (mean 11 months). Patient ages ranged from 3.5 to 22 years,

and disease duration ranged from 0.5 to 20 years.

All patients had fever and/or rash and laboratory evidence of systemic

inflammation (anemia, thrombocytosis, or elevated ESR), in addition to

active joint disease, at the time of beginning etanercept. All patients

were already taking other " second line " arthritis medications such as

corticosteroids, methotrexate, or cyclosporin A.

The clinical course of each patient was carefully followed with serial

joint examinations and laboratory testing. Four of nine children had an

excellent initial response of both systemic and joint inflammation, two

within 1 month and two within 2 months. However, all four experienced

major exacerbation of systemic and articular disease within 6 months of

institution of therapy.

Flares were temporally related to reduction of concomitant methotrexate

and/or corticosteroid dosages. In two patients who flared, control

of disease was re-established by increasing concomitant medication

dosage(s).

One of nine patients had objective improvement after nine months of

continuous etanercept treatment, perhaps unrelated to this medication.

Four other patients derived little or no benefit from etanercept,

despite an increase in dosage to 0.5 mg/kg in two.

Compared to seventeen polyarticular JRA patients receiving etanercept

and followed for a similar length of time, those with systemic JRA were

much less likely to have a dramatic response, or much more likely to

experience exacerbation of disease after initial improvement.

Session Info. : Poster Session: TNF Drugs in Pediatrics (12:30 PM-2:00

PM) Board Number: 195

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