1
|
Srinivasalu H, Simpson J, Stoll ML. Drug therapy in juvenile spondyloarthritis. Curr Opin Rheumatol 2024; 36:295-301. [PMID: 38639758 DOI: 10.1097/bor.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW This review summarizes latest developments in treatment of juvenile spondyloarthritis (JSpA), specifically enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA). RECENT FINDINGS There has been addition of biologic disease modifying antirheumatic drugs (bDMARDs) beyond tumor necrosis factor inhibitors (TNFi) for JSpA such as IL-17 blockers, IL-23 blockers, and janus activating kinase inhibitors with favorable safety profile. Conducting robust clinical trials for this subpopulation of JIA remains a challenge; extrapolation studies are being used to obtain approval from regulatory agencies. SUMMARY Newer drug therapies have expanded the scope of treatment for patients with JSpA. bDMARDs such as adalimumab, etanercept, infliximab, and secukinumab have demonstrated clinically significant treatment efficacy in ERA and JPsA. Based on extrapolation studies, intravenous golimumab, etanercept, abatacept, and ustekinumab have gained Food and Drug Administration (FDA) approval for JPsA. Long-term follow-up studies continue to demonstrate acceptable safety profiles. There is need for more real-world data on drug efficacy from Registry studies and research on effective de-escalation strategies.
Collapse
Affiliation(s)
- Hemalatha Srinivasalu
- GW University School of Medicine
- Division of Rheumatology, Children's National Hospital, Washington, DC
| | - Jessica Simpson
- Division of Rheumatology, Children's National Hospital, Washington, DC
| | - Matthew L Stoll
- Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
2
|
Shenoi S, Horneff G, Aggarwal A, Ravelli A. Treatment of non-systemic juvenile idiopathic arthritis. Nat Rev Rheumatol 2024; 20:170-181. [PMID: 38321298 DOI: 10.1038/s41584-024-01079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/08/2024]
Abstract
In the past two decades, the treatment of juvenile idiopathic arthritis (JIA) has evolved markedly, owing to the availability of a growing number of novel, potent and relatively safe therapeutic agents and the shift of management strategies towards early achievement of disease remission. However, JIA encompasses a heterogeneous group of diseases that require distinct treatment approaches. Furthermore, some old drugs, such as methotrexate, sulfasalazine and intraarticular glucocorticoids, still maintain an important therapeutic role. In the past 5 years, information on the efficacy and safety of drug therapies for JIA has been further enriched through the accomplishment of several randomized controlled trials of newer biologic and synthetic targeted DMARDs. In addition, a more rational therapeutic approach has been fostered by the promulgation of therapeutic recommendations and guidelines. A multinational collaborative effort has led to the development of the recommendations for the treat-to-target strategy in JIA. There is currently increasing interest in establishing the optimal time and modality for discontinuation of treatment in children with JIA who achieve sustained clinical remission. The aim of this Review is to summarize the current evidence and discuss the therapeutic approaches to the management of non-systemic phenotypes of JIA, including oligoarthritis, polyarthritis, enthesitis-related arthritis and psoriatic arthritis.
Collapse
Affiliation(s)
- Susan Shenoi
- Seattle Children's Hospital and Research Centre, University of Washington, Seattle, WA, USA
| | - Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy.
| |
Collapse
|
3
|
Naveen R, Guleria S, Aggarwal A. Recent updates in enthesitis-related arthritis. Rheumatol Int 2023; 43:409-420. [PMID: 36629936 DOI: 10.1007/s00296-023-05274-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis which belongs to the spectrum of diseases that are included in juvenile spondyloarthropathy. In recent years, there have been significant advances in understanding pathogenesis, tools to assess disease activity, early recognition of the axial disease, and targeted therapy using IL-17 inhibitors and small molecule inhibitors. The current narrative review highlights these new advances. Among many hypotheses linking HLA B27 to ERA, one of them is the effect of HLA B27 on gut dysbiosis. However, recent data suggest that gut dysbiosis is probably not determined by HLA B27. Though children present with arthritis and enthesitis, axial disease is present in 50-60% on MRI. Using data-driven approach, discriminative MRI finding for active and chronic diseases has been defined for children. This will help in the early recognition of disease. An abridged version of juvenile spondyloarthropathy disease activity (JSpADA) score without the need for acute phase reactants and Schober test performed as well as the original score may increase its acceptance in routine practice. Secukinumab (anti-IL-17 antibody) has shown a more than 75% response rate in children with ERA and may be a good alternative to anti-TNF therapy. Initial data with tofacitinib also look promising. All these will translate into better outcomes for children with ERA.
Collapse
Affiliation(s)
- R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Shivika Guleria
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| |
Collapse
|
4
|
Horneff G, Minden K, Rolland C, Daly ACH, Borlenghi C, Ruperto N. Efficacy and safety of TNF inhibitors in the treatment of juvenile idiopathic arthritis: a systematic literature review. Pediatr Rheumatol Online J 2023; 21:20. [PMID: 36829225 PMCID: PMC9951426 DOI: 10.1186/s12969-023-00798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/29/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE A systematic literature review was conducted to summarize efficacy and safety data from studies that evaluated tumor necrosis factor inhibitors in patients with juvenile idiopathic arthritis (JIA). METHODS Relevant publications were identified via online searches (cutoff: March 16, 2021). After screening search results, outcome data were extracted if the treatment arm included ≥ 30 patients. Outcomes were described narratively, with efficacy assessed by JIA-American College of Rheumatology (ACR) response criteria and safety assessed by the incidence of serious adverse events (SAEs) per 100 patient-years (100PY). RESULTS Among 87 relevant publications included in the qualitative synthesis, 19 publications described 13 clinical trials. Across the 13 trials, the percentages of patients who achieved JIA-ACR30/50/70/90 responses at Week 12 with adalimumab ranged 71-94%, 68-90%, 55-61%, and 39-42%, respectively; with etanercept (Week 12), 73-94%, 53-78%, 36-59%, and 28%; with golimumab (Week 16), 89%, 79%, 66%, and 36%; and with infliximab (Week 14), 64%, 50%, and 22% (JIA-ACR90 not reported). SAE incidence across all time points ranged 0-13.7 SAE/100PY for adalimumab, 0-20.0 SAE/100PY for etanercept, and 10.4-24.3 SAE/100PY for golimumab (1 study). SAE incidence could not be estimated from the 2 infliximab publications. CONCLUSION Tumor necrosis factor inhibitors are effective and well tolerated in the treatment of JIA, but additional evidence from head-to-head studies and over longer periods of time, especially in the context of the transition from pediatric to adult care, would be useful.
Collapse
Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany. .,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Kirsten Minden
- grid.413453.40000 0001 2224 3060German Rheumatism Research Centre Berlin (DRFZ), Leibniz Association, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Pediatric Pulmonology, Immunology, and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Genoa, Italy
| |
Collapse
|
5
|
Li J, Zhu Y, Guo G. Enthesitis-related arthritis: the clinical characteristics and factors related to MRI remission of sacroiliitis. BMC Musculoskelet Disord 2022; 23:1054. [DOI: 10.1186/s12891-022-06028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
To describe the clinical characteristics and explore the factors related to the MRI remission of sacroiliitis in patients with enthesitis-related arthritis (ERA).
Methods
Patients with ERA from 2018–2022 in our medical center were retrospectively reviewed, which identified according to Pediatric Rheumatology International Trials Organization (PRINTO) criteria. Demographics, clinical characteristics, examinations, and treatments were described. Univariate and multivariate logistic regression models were used to analyze the factors related to MRI remission of sacroiliitis in ERA.
Results
This retrospective study included 160 ERA patients (51.9% male) with a mean onset age of 9.2 ± 3.0 years. There were 144 cases (81.9%) with peripheral arthritis, and the hip, knee, and ankle joints were the most commonly involved joints. Enthesitis occurred in 48 cases (30.0%), and sacroiliitis occurred in 142 cases (88.5%) at diagnosis. Human leukocyte antigen (HLA)-B27 was positive in 33 cases (17.1%), and acute uveitis occurred in 3 cases (1.9%). The majority of patients (93.7%) were treated with disease-modifying anti-rheumatic drugs (DMARDs), and 60% with biologics. Among 62 patients with MRI-defined sacroiliitis, 27 (43.5%) cases showed improvement in the sacroiliac joint lesion after treatment. Multivariate logistic regression analysis showed that duration from onset to diagnosis of less than 3 months (OR = 3.609, 95% CI: 1.068–12.192) and active joints of more than 4 (OR = 4.916, 95% CI: 1.006–24.037) were independent factors.
Conclusion
We highlighted differences in ERA clinical characteristics. Patients with a shorter diagnosis time and more joint involvement improved more significantly in sacroiliac joint lesions after treatment.
Collapse
|
6
|
Oommen PT, Strauss T, Baltruschat K, Foeldvari I, Deuter C, Ganser G, Haas JP, Hinze C, Holzinger D, Hospach A, Huppertz HI, Illhardt A, Jung M, Kallinich T, Klein A, Minden K, Mönkemöller K, Mrusek S, Neudorf U, Dückers G, Niehues T, Schneider M, Schoof P, Thon A, Wachowsky M, Wagner N, Bloedt S, Hofer M, Tenbrock K, Schuetz C. Update of evidence- and consensus-based guidelines for the treatment of juvenile idiopathic arthritis (JIA) by the German Society of Pediatric and Juvenile Rheumatic Diseases (GKJR): New perspectives on interdisciplinary care. Clin Immunol 2022; 245:109143. [DOI: 10.1016/j.clim.2022.109143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
|
7
|
Burgos-Vargas R, Loyola-Sanchez A, Ramiro S, Reding-Bernal A, Alvarez-Hernandez E, van der Heijde D, Vázquez-Mellado J. A randomized, double-blind, placebo-controlled 12-week trial of infliximab in patients with juvenile-onset spondyloarthritis. Arthritis Res Ther 2022; 24:187. [PMID: 35941676 PMCID: PMC9358905 DOI: 10.1186/s13075-022-02877-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the efficacy and safety of infliximab versus placebo in the treatment of patients with juvenile-onset spondyloarthritis (JoSpA). Methods Phase III, randomized, double-blind, placebo-controlled trial of 12 weeks that included patients ≤ 18 years old with JoSpA not responding to nonsteroidal anti-inflammatory drugs, sulfasalazine, or methotrexate. Patients were randomly assigned 1:1 to the infusion of infliximab 5mg/kg or placebo; completers entered then an open-label extension (OLE) period of 42 weeks. The primary endpoint was the number of active joints. Secondary outcomes included the assessment of disease activity, tender entheses, spinal mobility, serum C-reactive protein (CRP), the Bath Ankylosing Spondylitis Disease Activity and Functional Index, and the Childhood Health Assessment Questionnaire (CHAQ). Results We randomized 12 patients to infliximab and 14 to placebo. No significant differences were found between groups at baseline. At week 12, the mean number of active joints was 1.4 (SD 2.4) in the infliximab group and 4.1 (SD 3.0) in the placebo group (p = 0.0002). A repeated-measures mixed model analysis that included all endpoints in the study demonstrated sustained favourable outcomes of infliximab for active joints, tender joints, swollen joints, and tender enthesis counts, as well as for CHAQ and CRP (p < 0.01). Adverse events were more frequent in the infliximab group, including infections and infusion reactions, but none of them was serious. Conclusion Infliximab is efficacious for patients with JoSpA with an inadequate response to conventional treatment. No serious adverse events with the use of infliximab were observed.
Collapse
Affiliation(s)
- Rubén Burgos-Vargas
- Department of Rheumatology, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Adalberto Loyola-Sanchez
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Department of Clinical Neurosciences, Alberta Health Services, Edmonton, Canada.
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Arturo Reding-Bernal
- Research Division, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | | | - Janitzia Vázquez-Mellado
- Department of Rheumatology, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| |
Collapse
|
8
|
Vilaiyuk S, Lerkvaleekul B, Jino J, Charuvanij S, Book YX, Arkachaisri T. Comparison of the outcomes between early and late anti-tumor necrosis factor therapy in patients with enthesitis-related subcategory of juvenile idiopathic arthritis: a multi-center study in Southeast Asia. Expert Opin Biol Ther 2022; 22:1323-1332. [PMID: 35876095 DOI: 10.1080/14712598.2022.2105140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the impact of delayed initiation of anti-tumor necrosis factor (TNF) therapy in patients with enthesitis-related arthritis (ERA). Here, we compared the impact of delayed treatment on disease outcomes of ERA patients in Southeast Asia. RESEARCH DESIGN AND METHODS This retrospective study enrolled 149 ERA patients from Thailand and Singapore. Early (e-aTNF) and late (l-aTNF) treatment groups received anti-TNF therapy starting at ≤6 months and >6 months, respectively, after diagnosis. Outcomes included mean differences in disease activity parameters, Juvenile Spondyloarthritis Disease Activity (JSpADA) score, Juvenile Arthritis Diseases Activity (JADAS)-10 score, and American College of Rheumatology Pediatric (ACR Pedi) criteria, and the frequency of clinically inactive disease and first flare event. RESULTS The mean changes in JSpADA (p = 0.002) and JADAS-10 (p < 0.001) scores over time were significantly higher in the e-aTNF group than in the l-aTNF group. A significantly higher proportion of patients in the e-aTNF group than l-aTNF group satisfied ACR Pedi 100 criteria at 2 years (p = 0.042). All other long-term outcomes were not significantly different between the groups. CONCLUSIONS Although early anti-TNF treatment improved disease activity parameters somewhat better than delayed anti-TNF therapy, there was no significant difference in long-term outcomes.
Collapse
Affiliation(s)
- Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Butsabong Lerkvaleekul
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Janejira Jino
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yun Xin Book
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, SingHealth, Duke-NUS medical school, Singapore, Singapore Singapore
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, SingHealth, Duke-NUS medical school, Singapore, Singapore Singapore
| |
Collapse
|
9
|
Hospach T, Horneff G, Poddubnyy D. [Spondyloarthritis in childhood and adulthood]. Z Rheumatol 2022; 81:14-21. [PMID: 34985566 DOI: 10.1007/s00393-021-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Axial spondylarthritis in adulthood (SpAA) is frequently initially manifested as a sacroiliitis, whereas this not true for enthesitis-related arthritis (EAA), which begins in childhood and adolescence. Classically, EAA begins with peripheral arthritis and only a part transitions into a juvenile SpA (jSpA) or SpAA. The criteria used for classification of SpAA and EAA are currently being validated and revised. For the first time imaging is included for EAA. For both diseases nonsteroidal anti-inflammatory drugs (NSAID) are initially used therapeutically, followed by biologicals or synthetic targeted disease-modifying drugs in refractory courses. Steroids should be avoided in long-term treatment. For optimal transition and further care in adulthood, a close cooperation between internistic and pediatric rheumatologists is necessary.
Collapse
Affiliation(s)
- Toni Hospach
- Zentrum für pädiatrische Rheumatologie, am Klinikum Stuttgart (ZEPRAS), Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - Gerd Horneff
- Rheumazentrum für Kinder und Jugendliche, St. Augustin, Deutschland
| | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité, Berlin, Deutschland
| |
Collapse
|
10
|
Abstract
Spondyloarthritis (SpA) is a blanket term encompassing entities such as enthesitis-related arthritis, nonradiographic axial SpA, and ankylosing spondylitis. These diseases share many clinical features, including a predilection for inflammation of the entheses and the sacroiliac joints. The nomenclature is based on the evolution of the classification of the disease and the age of the patient. SpA has a prevalence of approximately 1% of the population of the United States, with 10% to 20% of patients experiencing the onset during childhood. Children with onset of arthritis before age 16 years are classified as having juvenile idiopathic arthritis. Children with enthesitis and/or sacroiliitis are further classified as belonging to the enthesitis-related arthritis subtype of juvenile idiopathic arthritis. The initial manifestations can be subtle and will usually include a peripheral pattern of arthritis and enthesitis. It may take several years for axial disease to develop in children. Except for an association with the human leukocyte antigen (HLA-B27) serotype, there are no laboratory markers for the disease, and the radiographic findings are often negative. A careful clinical evaluation for evidence of inflammation in the entheses and the joints and a search for comorbidities are required. Magnetic resonance imaging facilitates the early detection of sacroiliitis, an important feature that may be clinically silent. Because recent studies indicate that earlier introduction of therapy can help achieve better outcomes, rapid identification and treatment of children with SpA is essential.
Collapse
Affiliation(s)
- Lita Aeder
- Department of Pediatrics, Brookdale University Hospital and Medical Center, New York, NY; and State University of New York Health Science Center at Brooklyn, Brooklyn, NY
| | - Karen B Onel
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY; and Department of Clinical Pediatrics, Weill Cornell Medicine, New York, NY
| |
Collapse
|
11
|
Reiff DD, Stoll ML, Cron RQ. Precision medicine in juvenile idiopathic arthritis-has the time arrived? THE LANCET. RHEUMATOLOGY 2021; 3:e808-e817. [PMID: 38297525 DOI: 10.1016/s2665-9913(21)00252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022]
Abstract
The introduction of disease-modifying anti-rheumatic drug therapies for treating children and adolescents with chronic arthritis (ie, juvenile idiopathic arthritis [JIA]) has revolutionised care and outcomes. The biologic revolution continues to expand, with ever-changing immunological targets coming to market after basic research and clinical trials. The first class of biologics that was beneficial for children with JIA was tumour necrosis factor (TNF) inhibitors. If used early and aggressively, TNF inhibitors are capable of inducing disease remission for most of the seven subtypes of JIA, with the exception of systemic JIA (which more frequently responds to interleukin [IL]-1 or IL-6 inhibition). Nevertheless, there are still subsets of patients with JIA with disease that is difficult to treat or who develop extra-articular features that require a different therapeutic approach. Although finding an effective biological therapy for individual children with JIA can be trial and error, ongoing research and clinical trials are providing insight into a more personalised approach to care. In addition, redefining the JIA classification, in part based on shared similarities with various adult arthritides, could allow for extrapolation of knowledge from studies in adults with chronic arthritis.
Collapse
Affiliation(s)
- Daniel D Reiff
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA
| | - Matthew L Stoll
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama, Birmingham, AL, USA.
| |
Collapse
|
12
|
Oliver M, Simard JF, Lee T, Gerstbacher D, Sandborg C. Determinants of Tumor Necrosis Factor Inhibitor Use in Juvenile Spondyloarthropathy and Impact on Clinical Disease Outcomes. ACR Open Rheumatol 2021; 4:19-26. [PMID: 34647693 PMCID: PMC8754014 DOI: 10.1002/acr2.11353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The objectives of this study were to characterize the reasons for tumor necrosis factor inhibitor (TNFi) initiation in patients with juvenile spondyloarthropathy (JSpA) and identify clinical correlates and to assess the effect of TNFi therapy on JSpA disease activity. Methods We conducted a retrospective cohort study of 86 patients with JSpA with first‐time use of a TNFi over a 7‐year period at Stanford Children's Health. We assessed the physician's reason for TNFi initiation, disease activity at 6 months, and clinical disease status at 12 months following TNFi start. Changes in active joint count, enthesitis count, and pain were measured. Demographics, physician reasons for TNFi initiation, and clinical characteristics were summarized. Results The mean age at JSpA diagnosis was 12.4 years (SD 4.0 years), and the mean time from diagnosis to TNFi initiation was 1.6 years (SD 2.3 years). The most common reason for initiating a TNFi was active disease on physical examination (61%). At 6 months post TNFi initiation, patients on average had three fewer active joints and one fewer active enthesitis point. Patient‐reported pain improved from moderate/severe to mild. After 12 months, 54% of patients had active disease. Conclusion The physician's decision to initiate a TNFi relied mostly on physical examination findings. Despite improvement in arthritis, enthesitis, and patient‐reported pain at 6 months post TNFi initiation, the majority of the patients still had active disease after 1 year of therapy.
Collapse
|
13
|
Abstract
Juvenile idiopathic arthritis is a group of heterogeneous chronic inflammatory arthropathies occurring in childhood without a known cause. This article discusses the key clinical features of juvenile idiopathic arthritis and treatment updates for oligoarthritis, polyarthritis, enthesitis-related arthritis, psoriatic arthritis, and systemic arthritis. Paradigm changes in management include the earlier use of biologic agents and the introduction of biosimilars and targeted synthetic disease modifying agents like tofacitinib. This review summarizes recent developments while considering potential areas for improvement and study.
Collapse
Affiliation(s)
- Karen Onel
- Division of Pediatric Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, 535 E 70th St 5th Floor, New York, NY 10021, USA
| | - Dax G Rumsey
- Department of Pediatrics, Division of Rheumatology, University of Alberta, 3-502 ECHA, 11405 87 Ave NW, Edmonton, AB T6G 1C9
| | - Susan Shenoi
- Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, MA.7.110, Sand Point Way NE, Seattle, WA 98105, USA.
| |
Collapse
|
14
|
Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
| | | |
Collapse
|
15
|
Maccora I, Lombardi N, Crescioli G, Bettiol A, Bonaiuti R, Pagnini I, Maniscalco V, Marrani E, Mastrolia MV, Ravaldi C, Consolini R, Cattalini M, Vannacci A, Simonini G. OBSIDIAn - real world evidence of Originator to BioSImilar Drug switch in juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 61:1518-1528. [PMID: 34273158 DOI: 10.1093/rheumatology/keab572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Limited data about use of biosimilars are available in children with Juvenile Idiopathic Arthritis (JIA). This study therefore aimed to evaluate long-term efficacy and safety of switching from etanercept (ETA) and adalimumab (ADA) originators to their biosimilars, in children with JIA, in a real-world setting. METHODS This is a retro-prospective non-interventional multicentre Italian comparative cohort study. Medical charts of JIA children treated with biosimilars of ETA or ADA were included. Efficacy and safety of TNF-inhibitors therapy was evaluated at last follow-up during originator and at 3, 6 and 12 months following the switch to biosimilar. RESULTS 59 children (42 female, median age at onset 88 months) were treated with biosimilar of ETA (21) and ADA (38). Forty-five switched from the originator to the BIO (17 ETA, 28 ADA). At time of switch, 12/17 patients on ETA and 18/28 on ADA were in remission. No significant difference has been found at 3, 6 and 12 months after the switch. Ten patients discontinued biosimilars due to disease remission (4 ETA, 3 ADA), family willing (1 ETA), occurrence of burning at injection site (1 ETA), and persistent activity (1 ADA). No statistically significant difference was observed between originator and BIOs, nor between originator and BIOs, and between ADA and ETA in time to disease remission achievement, time to relapse and number of patients who experienced AE. CONCLUSION Our real-life results seem to confirm the efficacy and safety profile of switching from originator of ADA and ETA to their respective BIOs also in paediatric patients with JIA.
Collapse
Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance; Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance; Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence; Florence, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| | - Claudia Ravaldi
- PeaRL - Perinatal Research Laboratory, University of Florence and CiaoLapo Foundation for Perinatal Health; Florence, Italy
| | - Rita Consolini
- Section of Clinical Immunology and Rheumatology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance; Florence, Italy.,PeaRL - Perinatal Research Laboratory, University of Florence and CiaoLapo Foundation for Perinatal Health; Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| |
Collapse
|
16
|
Fisher C, Ciurtin C, Leandro M, Sen D, Wedderburn LR. Similarities and Differences Between Juvenile and Adult Spondyloarthropathies. Front Med (Lausanne) 2021; 8:681621. [PMID: 34136509 PMCID: PMC8200411 DOI: 10.3389/fmed.2021.681621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis (SpA) encompasses a broad spectrum of conditions occurring from childhood to middle age. Key features of SpA include axial and peripheral arthritis, enthesitis, extra-articular manifestations, and a strong association with HLA-B27. These features are common across the ages but there are important differences between juvenile and adult onset disease. Juvenile SpA predominantly affects the peripheral joints and the incidence of axial arthritis increases with age. Enthesitis is important in early disease. This review article highlights the similarities and differences between juvenile and adult SpA including classification, pathogenesis, clinical features, imaging, therapeutic strategies, and disease outcomes. In addition, the impact of the biological transition from childhood to adulthood is explored including the importance of musculoskeletal and immunological maturation. We discuss how the changes associated with adolescence may be important in explaining age-related differences in the clinical phenotype between juvenile and adult SpA and their implications for the treatment of juvenile SpA.
Collapse
Affiliation(s)
- Corinne Fisher
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medicine, Department of Rheumatology (Bloomsbury), University College London, London, United Kingdom
| | - Maria Leandro
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medicine, Department of Rheumatology (Bloomsbury), University College London, London, United Kingdom
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom.,Infection, Immunity & Inflammation Teaching and Research Department University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| |
Collapse
|
17
|
Biologic disease modifying antirheumatic drugs and Janus kinase inhibitors in paediatric rheumatology - what we know and what we do not know from randomized controlled trials. Pediatr Rheumatol Online J 2021; 19:46. [PMID: 33766063 PMCID: PMC7995584 DOI: 10.1186/s12969-021-00514-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Biologic disease modifying antirheumatic drugs (bDMARDs) and Janus Kinase (JAK) inhibitors are prescribed in adult and paediatric rheumatology. Due to age-dependent changes, disease course, and pharmacokinetic processes paediatric patients with inflammatory rheumatic diseases (PiRD) differ from adult rheumatology patients. METHODS A systematic literature search for randomized clinical trials (RCTs) in PiRD treated with bDMARDs/JAK inhibitors was conducted on Medline, clinicaltrials.gov , clinicaltrialsregister.eu and conference abstracts as of July 2020. RCTs were included if (i) patients were aged ≤20 years, (ii) patients had a predefined rheumatic diagnosis and (iii) RCT reported predefined outcomes. Selected studies were excluded in case of (i) observational or single arm study or (ii) sample size ≤5 patients. Study characteristics were extracted. RESULTS Out of 608 screened references, 65 references were selected, reporting 35 unique RCTs. All 35 RCTs reported efficacy while 34/3 provided safety outcomes and 16/35 provided pharmacokinetic data. The most common investigated treatments were TNF inhibitors (60%), IL-1 inhibitors (17%) and IL-6 inhibitors (9%). No RCTs with published results were identified for baricitinib, brodalumab, certolizumab pegol, guselkumab, risankizumab, rituximab, sarilumab, secukinumab, tildrakizumab, or upadacitinib. In patients with juvenile idiopathic arthritis (JIA) 25/35 RCTs were conducted. The remaining 10 RCTs were performed in non-JIA patients including plaque psoriasis, Kawasaki Disease, systemic lupus erythematosus and non-infectious uveitis. In JIA-RCTs, the control arm was mainly placebo and the concomitant treatments were either methotrexate, non-steroidal anti-inflammatory drugs (NSAID) or corticosteroids. Non-JIA patients mostly received NSAID. There are ongoing trials investigating abatacept, adalimumab, baricitinib, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, risankizumab, secukinumab, tofacitinib and tildrakizumab. CONCLUSION Despite the FDA Modernization Act and support of major paediatric rheumatology networks, such as the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Paediatric Rheumatology International Trials Organization (PRINTO), which resulted in drug approval for PiRD indications, there are limited RCTs in PiRD patients. As therapy response is influenced by age-dependent changes, pharmacokinetic processes and disease course it is important to consider developmental changes in bDMARDs/JAK inhibitor use in PiRD patients. As such it is critical to collaborate and conduct international RCTs to appropriately investigate and characterize efficacy, safety and pharmacokinetics of bDMARDs/JAK inhibitors in paediatric rheumatology.
Collapse
|
18
|
Abstract
Juvenile spondyloarthritis is a subset of juvenile idiopathic arthritis (JIA) with onset in late childhood and adolescence and a strong association with human leukocyte antigen (HLA) B-27 positivity and familial aggregation that has the potential for axial involvement, potentially leading to ankylosing spondylitis. Current therapy for severe disease relies heavily on tumor necrosis factor inhibitors (TNFi). Treatment paradigms in children largely consist of extrapolation from studies on adults with spondyloarthritis. Additional therapies studied in adults include non-steroidal anti-inflammatory drugs (NSAIDs), blockade of the interleukin-17 (IL-17) and IL-23 axes, blockade of T-cell stimulation, phosphodiesterase (PDE)-4 inhibition, and Janus-activated kinase (JAK) pathway alteration. IL-17 blockade and IL-23 blockade are guideline approved after TNFi failure (and even as an alternative to TNFi) in adults, depending on concomitant inflammatory bowel and skin disease, with JAK and PDE-4 inhibition options following biologic failure. Neither pediatric nor adult guidelines address IL-6 blockade, T-cell co-stimulation blockade, or combination biologic therapy.
Collapse
Affiliation(s)
- John M Bridges
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Matthew L Stoll
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
19
|
Saougou IG, Markatseli TE, Voulgari PV, Drosos AA. Current Therapeutic Options for the Treatment of Juvenile Idiopathic Arthritis. Curr Rheumatol Rev 2020; 17:41-57. [PMID: 32942977 DOI: 10.2174/1573403x16999200917151805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease and an exclusion diagnosis that includes all forms of arthritis that persists for more than 6 weeks under the age of 16. Although there is not yet a cure for JIA, and recent advances in the therapeutic field have created a more hopeful present and future for the patients. In the past, therapies for JIA have depended on non-steroidal medication, conventional synthetic disease-modifying antirheumatic drugs and corticosteroids. However, over the last decades, the advent of biologic therapies in JIA contributed to the preservation of functional activity, control of pain, avoidance of joint damage, and extra-articular manifestations. Furthermore, over the last years, international institutions, such as the American College of Rheumatology, have released recommendations and guidelines for rheumatologists for optimal JIA management. All the above have revolutionized the treatment of JIA with promising outcomes. To this end, the relevant literature is reviewed and discussed appropriately.
Collapse
Affiliation(s)
- Ioanna G Saougou
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | - Theodora E Markatseli
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece
| |
Collapse
|
20
|
Marino A, De Souza M, Giani T, Cimaz R. Pharmacotherapy for juvenile spondyloarthritis: an overview of the available therapies. Expert Opin Pharmacother 2020; 21:2161-2168. [PMID: 32726179 DOI: 10.1080/14656566.2020.1796970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Spondyloarthropathies (SpA) represent a heterogeneous group of inflammatory arthritides with autoimmune pathogenesis that can affect both adults and children with peculiar features such as enthesitis, sacroiliac joint, and axial involvement. Since juvenile onset of SpA (JSpA) is not well codified by the current juvenile idiopathic arthritis classification, studies in this field are restricted to single categories and therefore cannot be exhaustive. This review aims to report recent advances in the treatment of JSpA. AREAS COVERED In order to assess the available therapies for JSpA, the authors have analyzed data obtained from retrospective and prospective studies, case reports, and case series, as well as from controlled trials. EXPERT OPINION Given the challenging classification of JSpA, research in this field has been restricted to single subcategories. Little is known of which patients are more likely to develop axial involvement leading to severe spinal damage. Whether TNF inhibitors are capable to prevent or stop disease progression, once started, is yet to be ascertained with structural damage still a matter for research. Therefore, trials on the efficacy of TNF inhibitors in JSpA are strongly advocated since they may help to elucidate their place as a treatment option.
Collapse
Affiliation(s)
- Achille Marino
- Department of Pediatrics, Desio's Hospital, ASST Monza, Desio, Italy
| | - Mirian De Souza
- Rheumatology, ASST G.Pini-CTO, University of Milan , Milan, Italy
| | - Teresa Giani
- Department of Medical Biotechnology, University of Siena , Siena, Italy.,Pediatric Rheumatology, Meyer Children's Hospital, Florence, Italy
| | - Rolando Cimaz
- Pediatric Rheumatology, ASST G.Pini-CTO , Milan, Italy.,Department of Clinical Sciences and Community Health, and Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan , Milan, Italy
| |
Collapse
|
21
|
Niehues T, Özgür TT. The Efficacy and Evidence-Based Use of Biologics in Children and Adolescents: Using Monoclonal Antibodies and Fusion Proteins as Treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:703-710. [PMID: 31711560 DOI: 10.3238/arztebl.2019.0703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Monoclonal antibodies (mAb) and fusion proteins (FP) are increasingly being used in children and adolescents. In this review, we analyze the evidence for their safety and efficacy in the treatment of the most common chronic inflammatory diseases. METHODS We systematically searched PubMed, AWMF.org, and other databases for high-quality trials (i.e., randomized controlled trials with clinical primary endpoints) and guidelines published at any time up to 10 December 2018 that dealt with mAb and FP that are approved for pediatric use. The search term was "monoclonal anti- body/fusion protein [e. g. adalimumab] AND children." RESULTS The 620 hits included 25 high-quality trials (20 of them manufacturer- sponsored) on 9 mAb/FP (omalizumab, adalimumab, etanercept, ustekinumab, infliximab, golimumab, anakinra, canakinumab, tocilizumab, and abatacept), as well as 6 guidelines (3 each of levels S3 and S2k) on the treatment of bronchial asthma, psoriasis, juvenile idopathic arthritis, and chronic inflammatory bowel diseases. For none of these conditions are mAb and FP the drugs of first choice. Adverse drug effects are rare but sometimes severe (infection, immune dysregulation, tumors). CONCLUSION The retrieved trials have deficiencies that make it difficult to reliably evaluate the efficacy, safety, and utility of mAb/FP for children and adolescents with chronic inflammatory diseases. mAb/FP nonetheless represent a treatment option to be considered in case conventional immune-modulating drugs are ineffective. Researcher-initiated, high-quality trials and manufacturer-independent, systematic long-term evaluations of adverse effects (e.g., tumors) are sorely needed.
Collapse
Affiliation(s)
- Tim Niehues
- Department of Pediatrics and Adolescent Medicine, HELIOS Klinikum Krefeld
| | | |
Collapse
|
22
|
Deligeorgakis D, Trachana M, Pratsidou-Gertsi P, Dimopoulou D, Haidich AB, Garyfallos A. Capturing the enthesitis related arthritis contemporary profile of Caucasian patients in the era of biologics. Rheumatol Int 2020; 40:941-949. [PMID: 32322980 DOI: 10.1007/s00296-020-04581-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/07/2020] [Indexed: 01/17/2023]
Abstract
To describe the profile of Enthesitis Related Arthritis' (ERA) patients, in the era of biologic DMARDs (bDMARDs). This retrospective cohort study included patients with ERA monitored on a 3-month schedule for at least 1 year. Their metric assessment included the disease status and damage by applying the contemporary tools clinical-Juvenile Arthritis Disease Activity Score (c-JADAS), Juvenile Spondyloarthritis Disease Activity Index (JSpADA), clinical remission (CR) on/off medication and Juvenile Arthritis Damage Index (JADI). 43 patients (males 26) were enrolled, with a mean disease onset of 10.75 years. Median lag time from diagnosis to bDMARDs was 8.5 months. Patients with sacroiliitis received earlier bDMARDs (hazard ratio, HR 3.26). 36/43 patients achieved CR on medication (median time 11 months), which was correlated with compliance (HR: 3.62). The percentage of CR in patients with or without sacroiliitis was 35% and 63% respectively (p = 0.02). Twenty patients (47%) experienced a flare following CR (75%). The median flare-free survival following CR on/off medication was 42 and 34 months, respectively. At the last evaluation, both median baseline cJADAS and JSpADA dropped to 0, 13/43 patients had a persistent disease activity, while 17/43 and 13/43 patients were in CR on/off medication, respectively. The median patient percentage of CR was 54% and no patient had a JADI > 0. Increased lag time to bDMARDs was associated with increased CR (Odds ratio: 1.48). Early administration of bDMARDs and compliance improved long-term outcome of ERA. Sacroiliitis was a negative prognostic factor with an increased need for bDMARDs and diminished rates of CR.
Collapse
Affiliation(s)
- Dimitrios Deligeorgakis
- 4th Department of Internal Medicine, School of Medicine, Rheumatology Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Maria Trachana
- 1st Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Centre, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polyxeni Pratsidou-Gertsi
- 1st Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Centre, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Dimopoulou
- 4th Department of Internal Medicine, School of Medicine, Rheumatology Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, School of Medicine, Social-Preventative Medicine and Medical Statistics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Garyfallos
- 4th Department of Internal Medicine, School of Medicine, Rheumatology Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
23
|
Cabrera N, Avila-Pedretti G, Belot A, Larbre JP, Mainbourg S, Duquesne A, Janiaud P, Kassai B, Cucherat M, Lega JC. The benefit–risk balance for biological agents in juvenile idiopathic arthritis: a meta-analysis of randomized clinical trials. Rheumatology (Oxford) 2020; 59:2226-2236. [DOI: 10.1093/rheumatology/keaa170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/05/2020] [Accepted: 02/22/2020] [Indexed: 12/28/2022] Open
Abstract
Abstract
Objective
To assess the net benefit of biological agents (BA) used in JIA.
Methods
We systematically searched databases up to March 2019 for randomized controlled trials (RCT) performed in JIA disease. Separate random-effects meta-analyses were conducted for efficacy (ACR paediatric score 30%, ACRpedi30) and serious adverse events for safety. In order to standardize the baseline risk, we performed a meta-analysis of baseline risk in the control group (for both efficacy and safety meta-analysis). The net benefit was determined as the risk difference of efficacy subtracted by the risk difference of safety.
Results
We included 19 trials: 11 parallel RCTs (754 patients) and 8 withdrawal RCTs (704 patients). The net benefit ranged from 2.4% (adalimumab) to 17.6% (etanercept), and from 2.4% (etanercept) to 36.7%, (abatacept) in parallel and withdrawal trials assessing non-systemic JIA, respectively. In the systemic JIA category, the net benefit ranged from 22.8% (rilonacept) to 70.3% (canakinumab), and from 32.3% (canakinumab) to 58.2% (tocilizumab) in parallel and withdrawal trials, respectively.
Conclusion
The results suggest that a greater number of patients experienced therapeutic success without serious adverse events in the systemic onset JIA category compared with the BAs for non-systemic JIA categories. Baseline risk, design of trial and JIA categories impact the measure of net benefit of BAs in JIA patients.
Collapse
Affiliation(s)
- Natalia Cabrera
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
| | | | - Alexandre Belot
- Department of Paediatric Rheumatology, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Lyon University Hospital, University of Lyon, Lyon
| | - Jean-Paul Larbre
- Department of Rheumatology, Hospices Civils de Lyon, Lyon University Hospital, University of Lyon, Pierre-Bénite
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hospices Civils de Lyon, University of Lyon, Pierre-Bénite
| | - Agnès Duquesne
- Department of Paediatric Rheumatology, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Lyon University Hospital, University of Lyon, Lyon
| | - Perrine Janiaud
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
| | - Behrouz Kassai
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
- Department of Pharmaco-toxicology, Clinical Investigation Centre 1407 - INSERM, Hospices Civils de Lyon, Lyon, France
| | - Michel Cucherat
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hospices Civils de Lyon, University of Lyon, Pierre-Bénite
| |
Collapse
|
24
|
Cimaz R, Maioli G, Calabrese G. Current and emerging biologics for the treatment of juvenile idiopathic arthritis. Expert Opin Biol Ther 2020; 20:725-740. [PMID: 32116038 DOI: 10.1080/14712598.2020.1733524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The management of a child with juvenile idiopathic arthritis (JIA) requires a combination of pharmacological, physical, and psychosocial therapies in order to induce disease remission, by controlling articular and systemic inflammation. This review aims to provide a comprehensive discussion on the biological therapies currently in use in the treatment of JIA referring to existing recommendations and clinical evidence. We also discuss on the emerging biological drugs actually under consideration. AREAS COVERED Recent findings on immunological mechanisms involved in the pathogenesis of the disease allowed us to identify several specific targets for biologic therapies. A systematic literature review was conducted between January 1997 and January 2020 on PubMed including national and international guidelines and recommendations, trials and case-control studies. EXPERT OPINION There is now a plethora of therapies that are directed against variable targets, and the physician has to choose the most appropriate available medication in order to achieve early and sustained remission with as few side effects as possible. Research is advancing very fast in order to be more and more specific in suppressing inflammatory pathways without harming natural defenses. Finally, pharmacoeconomic considerations will also be very important to deal with, considering the high cost of most of these molecules.
Collapse
Affiliation(s)
- Rolando Cimaz
- Pediatric Rheumatology Department, ASST-Gaetano Pini-CTO, Department of Clinical Sciences and Community Health, University of Milan , Milan, Italy.,Pediatric Rheumatology Department, ASST-Gaetano Pini-CTO, University of Milan , Milan, Italy
| | | | | |
Collapse
|
25
|
Nagy A, Mosdosi B, Simon D, Dergez T, Berki T. Peripheral Blood Lymphocyte Analysis in Oligo- and Polyarticular Juvenile Idiopathic Arthritis Patients Receiving Methotrexate or Adalimumab Therapy: A Cross-Sectional Study. Front Pediatr 2020; 8:614354. [PMID: 33363071 PMCID: PMC7758242 DOI: 10.3389/fped.2020.614354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for seven distinct chronic immune-mediated diseases. Disease-modifying anti-rheumatic drugs (DMARD) are used to treat the underlying joint inflammation as well as extra-articular manifestations. Immunosuppression is a considerable side effect of the drugs. The main goal of this study was to investigate the effect of different JIA therapies on leukocyte subpopulations, which play a role in immune-defense. Three study groups were established. The first group consisted of JIA patients treated with methotrexate solely, the second one received a combination of methotrexate (MTX) and adalimumab (ADA). The control group was made up of the patients' healthy siblings. A total of 63 children were recruited. Fourty-one children with JIA and 22 healthy controls were included in the study. The absolute number of CD3+ T-cells was significantly elevated in patients treated with biological therapy compared to healthy controls (p2 = 0.017). In contrast, the number of CD56+ natural killer cells was significantly lower in children receiving biological therapy in comparison with healthy donors (p2 = 0.039). A significant alteration was also demonstrated between patients treated with MTX and MTX/ADA group concerning CD 19+ B-cells (p3 = 0.042). This is the first study that demonstrates significant alterations in the number of B-cells and T-cells with a relative decrease of NK-cell ratios in JIA patients receiving different DMARD therapy. Clinical Trial Registration: NCT03833271. 21.01.2019.
Collapse
Affiliation(s)
- Arnold Nagy
- Department of Paediatrics, University of Pecs, Medical School, Pecs, Hungary
| | - Bernadett Mosdosi
- Department of Paediatrics, University of Pecs, Medical School, Pecs, Hungary
| | - Diana Simon
- Department of Immunology and Biotechnology, University of Pecs, Medical School, Pecs, Hungary
| | - Timea Dergez
- Institute of Bioanalysis, University of Pecs, Medical School, Pecs, Hungary
| | - Timea Berki
- Department of Immunology and Biotechnology, University of Pecs, Medical School, Pecs, Hungary
| |
Collapse
|
26
|
Diener C, Horneff G. Comparison of adverse events of biologicals for treatment of juvenile idiopathic arthritis: a systematic review. Expert Opin Drug Saf 2019; 18:719-732. [PMID: 31204508 DOI: 10.1080/14740338.2019.1632288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Treatment of juvenile idiopathic arthritis has changed rapidly since the introduction of various biologics almost twenty years ago. Many clinical trials have been performed to monitor efficacy and safety of new agents. The aim of this review is to summarize safety concerns, which were observed during prospective clinical trials. Methods: Since etanercept was the first biologic approved and remains the most frequently used, as first biologic in polyarticular JIA patients, the authors calculated the relative risk of the adverse events for all examined biologicals and compared the values with the value of etanercept. Results: Relative rates for all adverse events showed similar rates for etanercept, infliximab, golimumab, and tocilizumab, whereas adalimumab showed higher rates and abatacept lower rates. Comparison of rates for serious adverse events demonstrated, that rates seemed comparable for etanercept, adalimumab, infliximab, and tocilizumab. Again, abatacept showed a lower rate, whereas golimumab seems to have a higher relative risk for serious adverse events. Rate of infection was lowest in patients treated with abatacept or tocilizumab, patients treated with etanercept, adalimumab and Infliximab again had similar rates. Conclusion: The safety profiles of actually approved biologics are highly acceptable. However, further observation, especially long-term observation through registry studies, is required.
Collapse
Affiliation(s)
- C Diener
- a Department of General Paediatrics, Asklepios Klinik Sankt Augustin , Sankt Augustin , Germany
| | - G Horneff
- a Department of General Paediatrics, Asklepios Klinik Sankt Augustin , Sankt Augustin , Germany.,b Department of Paediatric and Adolescents Medicine, Medical Faculty, University Hospital of Cologne , Cologne , Germany
| |
Collapse
|
27
|
Cabrera N, Lega JC, Kassai B, Wouters C, Kondi A, Cannizzaro E, Woerner A, Chausset A, Roethlisberger S, Jeanneret C, Aeschlimann F, Malik S, Duquesne A, Kaiser D, Higel L, Maes A, Berthet G, Hentgen V, Kone-Paut I, Belot A, Hofer M. Safety of biological agents in paediatric rheumatic diseases: A real-life multicenter retrospective study using the JIRcohorte database. Joint Bone Spine 2019; 86:343-350. [DOI: 10.1016/j.jbspin.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/28/2018] [Indexed: 12/28/2022]
|
28
|
Mistry RR, Patro P, Agarwal V, Misra DP. Enthesitis-related arthritis: current perspectives. Open Access Rheumatol 2019; 11:19-31. [PMID: 30774484 PMCID: PMC6354696 DOI: 10.2147/oarrr.s163677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.
Collapse
Affiliation(s)
- Rutviz Rajendra Mistry
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Pallavi Patro
- Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| |
Collapse
|
29
|
Nagy A, Mátrai P, Hegyi P, Alizadeh H, Bajor J, Czopf L, Gyöngyi Z, Kiss Z, Márta K, Simon M, Szilágyi ÁL, Veres G, Mosdósi B. The effects of TNF-alpha inhibitor therapy on the incidence of infection in JIA children: a meta-analysis. Pediatr Rheumatol Online J 2019; 17:4. [PMID: 30658717 PMCID: PMC6339290 DOI: 10.1186/s12969-019-0305-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. The diagnosis is based on the underlying symptoms of arthritis with an exclusion of other diseases Biologic agents are increasingly used on the side of disease-modifying anti-rheumatic drugs (DMARD) in JIA treatment. MAIN BODY The aim of this meta-analysis was to investigate the observed infections in JIA children during tumor necrosis factor (TNF)-alpha inhibitor therapy. A systematic search of three databases (Medline via PubMed, Embase, Cochrane Library) was carried out up to May 2018. Published trials that evaluated the infectious adverse events in patients receiving TNF-alpha inhibitor vs. a control group were included in the analysis. Full-text data extraction was carried out independently by the investigators from ten relevant publications. 1434 patients received TNF-alpha inhibitor therapy; the control group consisted of 696 subjects. The analysis presented the risk of infection in the active treatment group (OR = 1.13; 95% CI: 0.76-1.69; p = 0.543). The majority of infections were upper respiratory tract infections (URTIs). Furthermore, the subgroup analysis demonstrated a higher infection rate in the observed localization. CONCLUSION Anti-TNF therapy slightly but not significantly increases the incidence of infection in JIA children compared to other therapies (GRADE: moderate evidence). The most common infections reported were mild URTIs. Further studies with larger patients number with a strong evidence level are crucially needed to finalize the answer whether anti-TNF therapy elevates and if yes on what extent the incidence of infection in JIA children. TRIAL REGISTRATION Prospero: CRD42017067873 .
Collapse
Affiliation(s)
- Arnold Nagy
- Department of Paediatrics, Medical School, University of Pécs, 7. József Attila street, Pécs, 7623, Hungary.
| | - Péter Mátrai
- 0000 0001 0663 9479grid.9679.1Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- 0000 0001 0663 9479grid.9679.1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary ,0000 0001 0663 9479grid.9679.1Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary ,0000 0001 1016 9625grid.9008.1Momentum Gastroenterology Multidisciplinary Research Group, Hungarian Academy of Sciences - University of Szeged, Szeged, Hungary
| | - Hussain Alizadeh
- 0000 0001 0663 9479grid.9679.1Division of Haematology, First Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- 0000 0001 0663 9479grid.9679.1Division of Gastroenterology, First Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Czopf
- 0000 0001 0663 9479grid.9679.1Division of Cardiology, First Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Gyöngyi
- 0000 0001 0663 9479grid.9679.1Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Kiss
- 0000 0001 0942 9821grid.11804.3cFirst Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Katalin Márta
- 0000 0001 0663 9479grid.9679.1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary ,0000 0001 0663 9479grid.9679.1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Mária Simon
- 0000 0001 0663 9479grid.9679.1Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Ágnes Lilla Szilágyi
- 0000 0001 0663 9479grid.9679.1Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Veres
- 0000 0001 1016 9625grid.9008.1Institute of Surgical Research, University of Szeged, Szeged, Hungary ,0000 0001 1088 8582grid.7122.6Department of Paediatrics, Medical School, University of Debrecen, Debrecen, Hungary
| | - Bernadett Mosdósi
- 0000 0001 0663 9479grid.9679.1Department of Paediatrics, Medical School, University of Pécs, 7. József Attila street, Pécs, 7623 Hungary
| |
Collapse
|
30
|
Aeschlimann FA, Chong SL, Lyons TW, Beinvogl BC, Góez-Mogollón LM, Tan S, Laxer RM. Risk of Serious Infections Associated with Biologic Agents in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analyses. J Pediatr 2019; 204:162-171.e3. [PMID: 30318371 DOI: 10.1016/j.jpeds.2018.08.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess whether treatment with biologic response modifying agents during clinical trial study periods increases the risk of serious infections in children with juvenile idiopathic arthritis (JIA). STUDY DESIGN A systematic literature review using Medline, Embase, Cochrane library, and the clinical trial registry was performed up to July 2017. Random effects meta-analyses were used to compare rates of serious infections in children with JIA given biologic agents compared with controls, and the pooled relative risk calculated. Subanalyses were performed for different biologic agent classes. RESULTS In total, 19 trials accounting for 21 individual studies were included (11 for tumor necrosis factor-alpha inhibitors [n = 814 patients], 3 for interleukin-6 inhibitors [n = 318], 6 for interleukin-1 inhibitors [n = 353], and 1 for selective T-lymphocyte costimulation modulators [n = 122]). Patients (68% female) had a mean age of 10.8 years. Seventeen serious infections were reported among 810 children receiving biologic agents and 15 among 797 controls. The most frequent infections were bronchopulmonary and varicella. No statistically significant difference in risk of serious infections was found between children receiving biologic agents compared with control groups (pooled relative risk = 1.13; 95% CI [0.63, 2.03]) during the trial study periods. The risk remained nonsignificant when evaluating the different classes of biologic agents separately. However, the analyses were underpowered to detect differences in the risk of serious infections overall or differences between classes of biologic agents. CONCLUSIONS In this systematic review and meta-analyses, serious infections were uncommon and not significantly increased among patients with JIA receiving biologic agents compared with controls. However, the analyses were underpowered and study periods were relatively short. Ongoing careful monitoring for serious infections remains necessary for all patients with JIA, and particularly those receiving biologic agents.
Collapse
Affiliation(s)
- Florence A Aeschlimann
- Pediatric Immunology-Hematology and Rheumatology Unit, University Hospital Necker-Enfants Malades, Paris, France.
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Beate C Beinvogl
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | | | - Sally Tan
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Abstract
Juvenile spondyloarthritis (SpA) is a distinct form of juvenile arthritis characterized by male predominance and adolescent onset. Clinical manifestations include lower extremity and sacroiliac joint arthritis, enthesitis, and subclinical gastrointestinal inflammation. Juvenile SpA is an immune-mediated inflammatory disease long recognized as associated with HLA-B27, which may be related to the microbial environment as suggested by its coexistence with reactive arthritis and psoriasis. Treatment of peripheral arthritis includes nonsteroidal anti-inflammatory drugs, joint injections, and disease-modifying agents, whereas treatment of axial disease may necessitate a tumor necrosis factor inhibitor biologic agent. Fewer than half of children achieve remission off medication 5 years after diagnosis.
Collapse
|
32
|
Ravelli A, Consolaro A, Horneff G, Laxer RM, Lovell DJ, Wulffraat NM, Akikusa JD, Al-Mayouf SM, Antón J, Avcin T, Berard RA, Beresford MW, Burgos-Vargas R, Cimaz R, De Benedetti F, Demirkaya E, Foell D, Itoh Y, Lahdenne P, Morgan EM, Quartier P, Ruperto N, Russo R, Saad-Magalhães C, Sawhney S, Scott C, Shenoi S, Swart JF, Uziel Y, Vastert SJ, Smolen JS. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis 2018; 77:819-828. [PMID: 29643108 DOI: 10.1136/annrheumdis-2018-213030] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022]
Abstract
Recent therapeutic advances in juvenile idiopathic arthritis (JIA) have made remission an achievable goal for most patients. Reaching this target leads to improved outcomes. The objective was to develop recommendations for treating JIA to target. A Steering Committee formulated a set of recommendations based on evidence derived from a systematic literature review. These were subsequently discussed, amended and voted on by an international Task Force of 30 paediatric rheumatologists in a consensus-based, Delphi-like procedure. Although the literature review did not reveal trials that compared a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated development of recommendations. The group agreed on six overarching principles and eight recommendations. The main treatment target, which should be based on a shared decision with parents/patients, was defined as remission, with the alternative target of low disease activity. The frequency and timeline of follow-up evaluations to ensure achievement and maintenance of the target depend on JIA category and level of disease activity. Additional recommendations emphasise the importance of ensuring adequate growth and development and avoiding long-term systemic glucocorticoid administration to maintain the target. All items were agreed on by more than 80% of the members of the Task Force. A research agenda was formulated. The Task Force developed recommendations for treating JIA to target, being aware that the evidence is not strong and needs to be expanded by future research. These recommendations can inform various stakeholders about strategies to reach optimal outcomes for JIA.
Collapse
Affiliation(s)
- Angelo Ravelli
- Clinica Pediatrica e Reumatologia, Università degli Studi di Genova and Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina, Genoa, Italy
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Università degli Studi di Genova and Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina, Genoa, Italy
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
- Department of Pediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ronald M Laxer
- Division od Rheumatology, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nico M Wulffraat
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Jonathan D Akikusa
- Rheumatology Unit, Department of General Medicine, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sulaiman M Al-Mayouf
- Department of Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center and Alfaisal University, Riyadh, Saudi Arabia
| | - Jordi Antón
- Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Medical Center Ljubljana and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Roberta A Berard
- Division of Rheumatology, Western University Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool and Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ruben Burgos-Vargas
- Rheumatology Department, Hospital General de México Eduardo Liceaga, México City, Mexico
| | - Rolando Cimaz
- Pediatric Rheumatology, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - Fabrizio De Benedetti
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Erkan Demirkaya
- Division of Rheumatology, Western University Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Dirk Foell
- Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Yasuhiko Itoh
- Department of Pediatrics, Nippon Medical School, Bunkyo City, Japan
| | - Pekka Lahdenne
- Institute of Clinical Medicine, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Esi M Morgan
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Pierre Quartier
- Paris-Descartes University, IMAGINE Institute, RAISE 22 National Reference Centre, Necker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris, France
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genoa, Italy
| | - Ricardo Russo
- Servicio de Inmunología y Reumatología, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | - Sujata Sawhney
- Department of Rheumatology, ISIC Superspeciality Hospital and Sir Ganga Ram Hospital, New Delhi, India
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Susan Shenoi
- Pediatric Rheumatology, Seattle Children's Hospital and Research Center, University of Washington, Seattle, Washington, USA
| | - Joost F Swart
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar-Saba, Israel
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Sebastiaan J Vastert
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine3, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
33
|
Goirand M, Breton S, Chevallier F, Duong NP, Uettwiller F, Melki I, Mouy R, Wouters C, Bader-Meunier B, Job-Deslandre C, Quartier P. Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre. Pediatr Rheumatol Online J 2018; 16:21. [PMID: 29609643 PMCID: PMC5879929 DOI: 10.1186/s12969-018-0238-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Childhood-onset spondyloarthropathies usually start with enthesitis and peripheral arthritis. However, axial disease may develop afterward. Patients are most often classified, following revised (Edmonton 2011) ILAR criteria, as enthesitis-related arthritis, psoriatic arthritis, or unclassified juvenile idiopathic arthritis, particularly in cases of psoriasis in the patient or a first-degree relative. In adults, peripheral spondyloarthritis is classified by ASAS criteria. METHODS We retrospectively studied patients with childhood-onset spondyloarthropathies followed for more than one year in our referral centre. We did not exclude patients with a personal or familial history of psoriasis. RESULTS We included 114 patients followed between January 2008 and December 2015 for a median of 2.5 years (IQR = 2.3). Sixty-nine per-cent of patients fulfilled the revised ILAR classification criteria for enthesitis-related arthritis, and 92% the ASAS criteria for peripheral spondyolarthritis (p < 0.001). Axial disease and sacroiliitis were rare at disease onset. However, they appeared during follow-up in 63% and 47% of cases respectively, after a median disease duration of 2.6 (IC 95% [2.2-4.4]) and 5.3 years (IC 95% [4.1-7.7]), respectively. Multivariable analysis showed that familial history of spondyloarthritis was associated with the presence of sacroiliitis and active disease at the latest follow-up (OR = 3.61 [1.5-8.7], p < 0.01 and 2.98 [1.2-7.3], p = 0.02, respectively). CONCLUSION Axial involvement developed in most patients within five years. Revised Edmonton criteria were less sensitive than ASAS criteria to classify patients as having childhood-onset spondyloarthropathies. The main risk factor for both sacroiliitis and persistent active disease was a familial history of spondyloarthritis.
Collapse
Affiliation(s)
- Maxime Goirand
- Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l'Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15, Paris, France. .,Paris Descartes University, 12 rue de l'Ecole de Médicine, 75006, Paris, France. .,GOIRAND, CETD et EMASP pédiatrique, Hôpital Robert Debré, 48, Boulevard Serrurier, 75019, Paris, France.
| | - Sylvain Breton
- 0000 0001 2175 4109grid.50550.35Pediatric Radiology Department, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex 15 Paris, France
| | - Frédéric Chevallier
- 0000000121496883grid.11318.3aUFR SMBH Paris 13, 74 rue Marcel Cachin, 93017 Cedex Bobigny, France
| | - Ngoc-Phoi Duong
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,0000 0004 1765 2136grid.414145.1Service de Réanimation Néonatale, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Florence Uettwiller
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Isabelle Melki
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France ,0000 0001 2175 4109grid.50550.35General Pediatrics, Infectious Disease, and Internal Medicine Unit, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France ,0000000121866389grid.7429.8INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation, Paris, France
| | - Richard Mouy
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Carine Wouters
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Brigitte Bader-Meunier
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| | - Chantal Job-Deslandre
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France
| | - Pierre Quartier
- 0000 0001 2175 4109grid.50550.35Pediatric Immunology, Hematology, and Rheumatology Unit, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE) ; Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, 149, rue de Sèvres, 75743 Cedex15 Paris, France ,0000 0001 2188 0914grid.10992.33Paris Descartes University, 12 rue de l’Ecole de Médicine, 75006 Paris, France ,grid.462336.6Imagine Institute, 24 boulevard du Montparnasse, 75015 Paris, France
| |
Collapse
|
34
|
Current and future perspectives in the management of juvenile idiopathic arthritis. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:360-370. [PMID: 30169269 DOI: 10.1016/s2352-4642(18)30034-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
Abstract
The treatment of juvenile idiopathic arthritis has improved tremendously in the past 20 years as a result of appropriate legislative initiatives, large international collaborative networks, and the availability of new potent medications. Despite these considerable advances, a sizable proportion of patients are still resistant to treatment. Further improvement will stem from a better definition of the disease entities under the broad term juvenile idiopathic arthritis (which includes all forms of arthritis with disease onset before the age of 16 years); the discovery of laboratory and imaging biomarkers that could help the tuning of therapy; smoother implementation of clinical trials; more standardised links between academia, regulatory authorities, and patient organisations for the planning of future trials; and the availability of new drugs that selectively target molecules or pathways involved in inflammation.
Collapse
|
35
|
Horneff G. Tumour necrosis factor inhibitors in enthesitis related arthritis and juvenile spondylarthropathies. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1433032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Pediatric and Adolescents medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
36
|
Affiliation(s)
- Ethan S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children and School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children and School of Clinical Sciences, University of Bristol, Bristol, UK.
| |
Collapse
|
37
|
Cimaz R, Marino A, Martini A. How I treat juvenile idiopathic arthritis: A state of the art review. Autoimmun Rev 2017; 16:1008-1015. [DOI: 10.1016/j.autrev.2017.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022]
|
38
|
Weiss PF, Xiao R, Brandon TG, Pagnini I, Wright TB, Beukelman T, Morgan-DeWitt E, Feudtner C. Comparative Effectiveness of Tumor Necrosis Factor Agents and Disease-modifying Antirheumatic Therapy in Children with Enthesitis-related Arthritis: The First Year after Diagnosis. J Rheumatol 2017; 45:107-114. [PMID: 28916542 DOI: 10.3899/jrheum.170251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize the effect of anti-tumor necrosis factor (TNF) therapy compared to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in children with enthesitis-related arthritis (ERA) over the first year after diagnosis. METHODS We conducted a multicenter retrospective comparative effectiveness study of children diagnosed with ERA. We estimated the effect of anti-TNF therapy on clinical variables (active joint count, tender entheses count) and patient-reported pain and global assessment of disease activity over the first year after diagnosis using state-of-the-art comparative effectiveness analytic methods. RESULTS During the study period, 217 patients newly diagnosed with ERA had a total of 965 clinic visits the first year after disease diagnosis. Children [median age 11.6 yrs, interquartile range 10-14] were treated with anti-TNF monotherapy (n = 33, 15.2%), csDMARD monotherapy (n = 73, 33.6%), or both (n = 52, 23.9%) in the first year after disease diagnosis. There was a statistically significant improvement in the primary outcome, active joint count, over time in children who received an anti-TNF drug versus those who did not (p = 0.03). Additionally, use of anti-TNF therapy versus no anti-TNF therapy was associated with less patient-reported pain (p < 0.01) and improved disease activity over time as assessed by the clinical Juvenile Arthritis Disease Activity Score (p < 0.01). The magnitude of estimated effect on clinical outcomes was uniformly greater, with the exception of tender entheses count, in children treated with an anti-TNF drug versus a csDMARD. CONCLUSION During the first year after diagnosis, anti-TNF exposure was associated with benefits for several clinically meaningful outcomes in children with enthesitis-related arthritis.
Collapse
Affiliation(s)
- Pamela F Weiss
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy. .,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Rui Xiao
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Timothy G Brandon
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Ilaria Pagnini
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Tracey B Wright
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Timothy Beukelman
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Esi Morgan-DeWitt
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Chris Feudtner
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| |
Collapse
|
39
|
Balato A, Scala E, Balato N, Caiazzo G, Di Caprio R, Monfrecola G, Raimondo A, Lembo S, Ayala F. Biologics that inhibit the Th17 pathway and related cytokines to treat inflammatory disorders. Expert Opin Biol Ther 2017; 17:1363-1374. [PMID: 28791896 DOI: 10.1080/14712598.2017.1363884] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Advances in the understanding of TNF-α and IL-17 synergistic functions have recently led to the concept that patients who do not respond or who respond inadequately to TNF-α inhibitors may have IL-17-driven diseases, opening up the way for a new class of therapeutic development: Th17-inhibitors. Areas covered: In this review, the authors discuss the central role that the IL-23/Th17 axis plays in the pathogenesis of several inflammatory diseases, such as psoriasis, highlighting its position as a relevant therapeutic target. In particular, the authors start by giving a brief historical excursus on biologic agent development up until the success of TNF-α inhibitors, and continue with an overview of IL12/23 pathway inhibition. Next, they describe Th17 cell biology, focusing on the role of IL-17 in host defense and in human immune-inflammatory diseases, discussing the use and side effects of IL-17 inhibitors. Expert opinion: The IL-23/Th17 signaling pathway plays a central role in the pathogenesis of several inflammatory diseases, such as psoriasis. Recent data has demonstrated that biologics neutralizing IL-17 (ixekizumab, secukinumab) or its receptor (brodalumab) are highly effective with a positive safety profile in treating moderate to severe psoriasis, offering new treatment possibilities, especially for patients who do not respond adequately to anti-TNF-α therapies.
Collapse
Affiliation(s)
- Anna Balato
- a Department of Advanced Biomedical Sciences , University of Naples Federico II , Naples , Italy
| | - Emanuele Scala
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Nicola Balato
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Giuseppina Caiazzo
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Roberta Di Caprio
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Giuseppe Monfrecola
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Annunziata Raimondo
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Serena Lembo
- c Department of Medicine, Surgery and Dentistry , "Scuola Medica Salernitana" University of Salerno , Salerno , Italy
| | - Fabio Ayala
- b Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| |
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW This review provides a detailed update regarding the genetics, pathogenesis, disease phenotype evaluation, therapies and expected outcomes for children with enthesitis-related arthritis (ERA). RECENT FINDINGS Recent studies evaluated human leukocyte antigen (HLA)-B27 subtypes and non-major histocompatibility complex genes including toll like receptor 4, NLRP3, CXCR4 and PTPN12 in children with ERA. The microbiome and γδ-T cells have also been an area of active investigation. Several studies focus on the imaging phenotype of children with ERA, including the use of ultrasonography and MRI. MRI techniques studied in this population include dedicated MRI, whole-body MRI and diffusion-weighted imaging. Conventional and biologic disease-modifying agents continue to be the mainstay of therapy, though the past 2 years have witnessed several greatly needed randomized controlled trials to study the efficacy of these medications in ERA. Finally, long-term effectiveness studies of biologics in children with ERA have helped inform provider and patient expectations of disease response and prognosis. SUMMARY Further evaluation of the role of the microbiome and the interleukin 17/interleukin 23 axis, techniques to optimize evaluation of disease features, and efficacy and effectiveness of newer medications are greatly needed in this understudied population of children.
Collapse
|
41
|
Lee JJ, Feldman BM. Clinical Trial Designs in Juvenile Idiopathic Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
42
|
Berard RA, Laxer RM. Learning the hard way: clinical trials in juvenile idiopathic arthritis. Ann Rheum Dis 2017; 77:1-2. [PMID: 28546255 DOI: 10.1136/annrheumdis-2017-211108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Roberta A Berard
- Division of Rheumatology, Children's Hospital, London Health Sciences Centre, Western University, London, Canada
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| |
Collapse
|
43
|
Abstract
The juvenile spondyloarthropathies (JSpA) are a group of related rheumatic diseases characterized by involvement of peripheral large joints, axial joints, and entheses (enthesitis) that begin in the early years of life (prior to 16(th) birthday).The nomenclature and concept of spondyloarthropathies has changed during the last few decades. Although there is not any specific classification of JSpA, diseases under the spondyloarthropathy nomenclature umbrella in the younger patients include: the seronegative enthesitis and arthropathy (SEA) syndrome, juvenile ankylosing spondylitis, reactive arthritis, and inflammatory bowel disease-associated arthritis. Moreover, the ILAR criteria for Juvenile Idiopathic Arthritis includes two categories closely related to spondyloarthritis: Enthesitis-related arthritis and psoriatic arthritis.We review the pathophysiology and the use of biological agents in JSpA. JSpA are idiopathic inflammatory diseases driven by an altered balance in the proinflammatory cytokines. There is ample evidence on the role of tumor necrosis factor (TNF) and interleukin-17 in the physiopathology of these entities. Several non-biologic and biologic agents have been used with conflicting results in the treatment of these complex diseases. The efficacy and safety of anti-TNF agents, such as etanercept, infliximab and adalimumab, have been analysed in controlled and uncontrolled trials, usually showing satisfactory outcomes. Other biologic agents, such as abatacept, tocilizumab and rituximab, have been insufficiently studied and their role in the therapy of SpA is uncertain. Interleukin-17-blocking agents are promising alternatives for the treatment of JSpA patients in the near future. Recommendations for the treatment of patients with JSpA have recently been proposed and are discussed in the present review.
Collapse
Affiliation(s)
- María Martha Katsicas
- Service of Immunology & Rheumatology, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina
| | - Ricardo Russo
- Service of Immunology & Rheumatology, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina
| |
Collapse
|
44
|
Taddio A, Cattalini M, Simonini G, Cimaz R. Recent advances in the use of Anti-TNFα therapy for the treatment of juvenile idiopathic arthritis. Expert Rev Clin Immunol 2016; 12:641-9. [DOI: 10.1586/1744666x.2016.1146132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
45
|
Aggarwal A, Misra DP. Enthesitis-related arthritis. Clin Rheumatol 2015; 34:1839-46. [PMID: 26233720 DOI: 10.1007/s10067-015-3029-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/30/2015] [Accepted: 07/19/2015] [Indexed: 01/17/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis of childhood. Currently, it is characterized by seven categories. The enthesitis-related arthritis (ERA) category usually affects boys older than 6 years and presents with lower limb asymmetrical arthritis associated with enthesitis. Later, these children can develop inflammatory lumbosacral pain (IBP). These children are at risk of developing acute anterior uveitis. A recently devised disease activity index, Juvenile Spondyloarthropathy Disease Activity Index (JSpADA), has been validated in retrospective cohorts. The corner stone of treatment is NSAIDs, local corticosteroid injections, and exercise. Methotrexate and sulfasalazine can be used for peripheral arthritis while anti-tumor necrosis factor (TNF) agents are sometimes used to treat refractory enthesitis and sacroiliitis. Almost two third of patients with ERA have persistent disease and often have impairments in their quality of life. The presence of hip or ankle arthritis and a family history of spondyloarthropathy or polyarticular joint involvement at onset are associated with poorer prognosis.
Collapse
Affiliation(s)
- Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow, Uttar Pradesh, 226014, India
| |
Collapse
|
46
|
Zhong Y, Wang Y, Guo J, Chu H, Gao Y, Pang L. Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study. TOHOKU J EXP MED 2015; 237:183-91. [PMID: 26477692 DOI: 10.1620/tjem.237.183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yingjie Zhong
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Ye Wang
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Jun Guo
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Haifeng Chu
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Yong Gao
- Department of Emergency Internal, China-Japan Union Hospital of Jilin University
| | - Limin Pang
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| |
Collapse
|