Anti-TNF Drugs Seem Safe and Effective for Juvenile Spondyloarthritis


TNF-alpha inhibitors work as well in juveniles with SpA as in adults, giving good long-term results, according to a small observational study conducted in 3 countries.

Hugle B, Burgos-Vargas R, Inman RD, et al., Long-term outcome of anti-tumor necrosis factor alpha blockade in the treatment of juvenile spondyloarthritis.Clin Exp Rheumatol. 2014 Jan 3. [Epub ahead of print]

A small observational study conducted in Canada, Germany, and Spain suggests that anti-tumor necrosis factor-alpha (TNF-α) drugs are just as safe and effective long-term in juvenile spondyloarthritis (JSpA) as they are in adults.

The open-label study of 16 patients with JSpA and related disorders refractory to non-steroidal anti-inflammatory drugs (NSAIDs) and to methotrexate (MTX)  found that the majority reached clinical remission within 6 months with TNF-α inhibitors -- and maintained low disease activity in joints for up to 7 years.

The only exceptions were patients with hip disease, two of whom required hip replacements at 3 and 8 years, respectively.

Conventional JSpA treatments, NSAIDs and cor­ticosteroids, relieve symptoms but have little effect on long-term damage. And while anti-TNF-α drugs are safe and effective in adult-onset SpA, there are no long-term data in children with enthesitis-related arthritis (ERA).

The study group, mostly teenage boys, took etanercept (n=10) or infliximab (n=6) and were observed for a median of 7.2 years.

As early as 6 weeks after beginning this treatment, patients showed significant improvement -- a median of 0 total active joint counts (TAJCs) and tender entheseal counts (TECs).  By 6 months, 83% met criteria for clinical remission (both a TAC and TEC of 0 at any time period), an effect that was sustained over follow-up. Ten patients followed in a prior short-term trial had similar results.

The authors say that radiographic evidence suggests TNF-α drugs are less effective in controlling sacroiliac joint disease.

In the study group, 6 patients (38%) had an arthritic flare at around two years. Two patients had mild temporary drug reactions, but there were no other adverse events.

Related Videos
Experts discuss fibromyalgia.
Expert on fibromyalgia.
Expert on fibromyalgia.
Expert on fibromyalgia.
Experts on fibromyalgia.
Expert on fibromyalgia.
Related Content
© 2023 MJH Life Sciences

All rights reserved.