Challenges in the management of juvenile idiopathic arthritis with etanercept

Clare E Pain, Liza J McCannAlder Hey Children&rsquo;s NHS Foundation Trust, Eaton Road, Liverpool, UKAbstract: Biologic agents have been designed with the help of immunological studies to target particular areas of the immune system which are thought to play a role in the pathogenesis of dis...

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Autores principales:	Clare E Pain, Liza J McCann
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2009
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/064cf087337f4644b211a48895a2b1b1
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spelling	oai:doaj.org-article:064cf087337f4644b211a48895a2b1b12021-12-02T01:20:50ZChallenges in the management of juvenile idiopathic arthritis with etanercept1177-54751177-5491https://doaj.org/article/064cf087337f4644b211a48895a2b1b12009-03-01T00:00:00Zhttp://www.dovepress.com/challenges-in-the-management-of-juvenile-idiopathic-arthritis-with-eta-a2957https://doaj.org/toc/1177-5475https://doaj.org/toc/1177-5491Clare E Pain, Liza J McCannAlder Hey Children&rsquo;s NHS Foundation Trust, Eaton Road, Liverpool, UKAbstract: Biologic agents have been designed with the help of immunological studies to target particular areas of the immune system which are thought to play a role in the pathogenesis of disease. Etanercept is a soluble anti-tumor necrosis factor alpha (TNF-&alpha;) agent licensed for the treatment of active poly-articular juvenile idiopathic arthritis (JIA) in children aged 4 to 17 years who have failed to respond to methotrexate alone, or who have been intolerant of methotrexate. The safety and efficacy of etanercept in this patient group has been established by one randomized controlled trial and several longitudinal studies. This, together with the fact that until recently etanercept was the only anti-TNF licensed in JIA, has made it the most common first choice biologic for many clinicians. However, there are still many unanswered questions about etanercept, including its efficacy and safety in different subtypes of JIA, in children under 4 years of age and in those with uveitis. There are still concerns about the long term safety of TNF antagonists in the pediatric age group and unanswered questions about increased risks of malignancy and infection. Although adult studies are useful to improve understanding of these risks, they are not a substitute for good quality pediatric research and follow-up studies. Adult trials often include greater numbers of patients. However, they evaluate a different population and drug behavior may vary in children due to differences in metabolism, growth and impact on a developing immune system. In addition, rheumatoid arthritis is a different disease than JIA. Clinicians need to carefully weigh up the risk benefit ratio of anti-TNF use in children with JIA and push for robust clinical trials to address the questions that remain unanswered. This article summarizes the evidence available for use of etanercept in children with JIA and highlights aspects of treatment in need of further research.Keywords: juvenile idiopathic arthritis, biologic therapy, etanercept Clare E PainLiza J McCannDove Medical PressarticleMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol 2009, Iss default, Pp 127-139 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Clare E Pain Liza J McCann Challenges in the management of juvenile idiopathic arthritis with etanercept
description	Clare E Pain, Liza J McCannAlder Hey Children&rsquo;s NHS Foundation Trust, Eaton Road, Liverpool, UKAbstract: Biologic agents have been designed with the help of immunological studies to target particular areas of the immune system which are thought to play a role in the pathogenesis of disease. Etanercept is a soluble anti-tumor necrosis factor alpha (TNF-&alpha;) agent licensed for the treatment of active poly-articular juvenile idiopathic arthritis (JIA) in children aged 4 to 17 years who have failed to respond to methotrexate alone, or who have been intolerant of methotrexate. The safety and efficacy of etanercept in this patient group has been established by one randomized controlled trial and several longitudinal studies. This, together with the fact that until recently etanercept was the only anti-TNF licensed in JIA, has made it the most common first choice biologic for many clinicians. However, there are still many unanswered questions about etanercept, including its efficacy and safety in different subtypes of JIA, in children under 4 years of age and in those with uveitis. There are still concerns about the long term safety of TNF antagonists in the pediatric age group and unanswered questions about increased risks of malignancy and infection. Although adult studies are useful to improve understanding of these risks, they are not a substitute for good quality pediatric research and follow-up studies. Adult trials often include greater numbers of patients. However, they evaluate a different population and drug behavior may vary in children due to differences in metabolism, growth and impact on a developing immune system. In addition, rheumatoid arthritis is a different disease than JIA. Clinicians need to carefully weigh up the risk benefit ratio of anti-TNF use in children with JIA and push for robust clinical trials to address the questions that remain unanswered. This article summarizes the evidence available for use of etanercept in children with JIA and highlights aspects of treatment in need of further research.Keywords: juvenile idiopathic arthritis, biologic therapy, etanercept
format	article
author	Clare E Pain Liza J McCann
author_facet	Clare E Pain Liza J McCann
author_sort	Clare E Pain
title	Challenges in the management of juvenile idiopathic arthritis with etanercept
title_short	Challenges in the management of juvenile idiopathic arthritis with etanercept
title_full	Challenges in the management of juvenile idiopathic arthritis with etanercept
title_fullStr	Challenges in the management of juvenile idiopathic arthritis with etanercept
title_full_unstemmed	Challenges in the management of juvenile idiopathic arthritis with etanercept
title_sort	challenges in the management of juvenile idiopathic arthritis with etanercept
publisher	Dove Medical Press
publishDate	2009
url	https://doaj.org/article/064cf087337f4644b211a48895a2b1b1
work_keys_str_mv	AT clareepain challengesinthemanagementofjuvenileidiopathicarthritiswithetanercept AT lizajmccann challengesinthemanagementofjuvenileidiopathicarthritiswithetanercept
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Challenges in the management of juvenile idiopathic arthritis with etanercept

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