Anti-TNF Drugs Seem Safe and Effective for Juvenile Spondyloarthritis

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.