Rheumatology International

, Volume 35, Issue 2, pp 323–326 | Cite as

Efficacy and safety of TNF-alpha antagonists in children with juvenile idiopathic arthritis who started treatment under 4 years of age

  • Clara Giménez-RocaEmail author
  • Estíbaliz Iglesias
  • Vicenç Torrente-Segarra
  • Rosa Bou
  • Judith Sánchez-Manubens
  • Joan Calzada-Hernández
  • Samuel Hernández
  • Sílvia Ricart
  • Jordi Antón
Short Communication


The aims of the study were to assess efficacy and safety of TNF-alpha antagonists (anti-TNF) in a cohort of patients with juvenile idiopathic arthritis (JIA) who began treatment under 4 years old and to assess relapse rate after methotrexate and/or anti-TNF withdrawal. We made a retrospective charts review of our non-systemic JIA patients treated with anti-TNF under 4 years of age between January 2006 and April 2013. Demographics, epidemiologic, clinical, laboratory data and rate of relapse after treatment withdrawal due to clinical remission were collected. Efficacy and safety end points included side effects (SE) and time to achieve clinical remission. We included 27 patients, 23 received etanercept and 4 adalimumab with a median age of 3.01 (range 0.88–3.97) years at anti-TNF beginning and 1.94 (range 0.18–5.44) and 2.39 (range 0.18–7.24) years of treatment and follow-up, respectively. All patients had previously received disease-modifying antirheumatic drugs at optimal dose. Nineteen patients reached clinical remission on treatment in a median time of 9.1 (range 6.23–21.17) months. Four of those relapsed during treatment. Six developed mild SE, mostly mild infections. No serious SE were described. Eleven patients who reached clinical remission relapsed after treatment withdrawal. None achieved clinical remission off treatment. Most patients reached clinical remission on anti-TNF. In our cohort of patients, etanercept and adalimumab were safe, with mostly mild infections and no serious SE. We observed a high relapse rate during treatment withdrawal.


Juvenile idiopathic arthritis Tumor necrosis factor inhibitors Etanercept Adalimumab Safety Efficacy 


Conflict of interest

No conflict of interest to declare.


  1. 1.
    Cassidy JT, Petty RE (2011) Chronic arthritis in childhood. In: Cassidy JT, Petty RE (eds) Textbook of pediatric rheumatology, 6th edn. Elsevier Saunders, Philadelphia, pp 213–214Google Scholar
  2. 2.
    Modesto C, Antón J, Rodríguez B, Bou R, Arnal C, Ros J et al (2010) Incidence and prevalence of juvenile idiopathic arthritis in Catalonia (Spain). Scand J Rheumatol 39:472–479PubMedCrossRefGoogle Scholar
  3. 3.
    Huemer C, Huemer M, Dorner T, Falger J, Schacherl H, Bernecker M et al (2001) Incidence of pediatric rheumatic diseases in a regional population in Austria. J Rheumatol 28:2116–2119PubMedGoogle Scholar
  4. 4.
    Prieur AM, Le Gall E, Karman F, Edan C, Lasserre O, Goujard J (1987) Epidemiologic survey of juvenile chronic arthritis in France. Comparison of data obtained from two different regions. Clin Exp Rheumatol 5:217–223PubMedGoogle Scholar
  5. 5.
    Moe N, Rygg M (1998) Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study. Clin Exp Rheumatol 16:99–101PubMedGoogle Scholar
  6. 6.
    Kaipiainen-Seppanen O, Savolainen A (1996) Incidence of chronic juvenile rheumatic diseases in Finland during 1980–1990. Clin Exp Rheumatol 14:441–444PubMedGoogle Scholar
  7. 7.
    Shaw KL, Southwood TR, Duffy CM, McDonagh JE (2006) Health-related quality of life in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 55:199–207PubMedCrossRefGoogle Scholar
  8. 8.
    Oliveira S, Ravelli A, Pistorio A, Castell E, Malattia C, Prieur AM et al (2007) Proxy-reported health-related quality of life of patients with juvenile idiopathic arthritis: the Pediatric Rheumatology International Trials Organization Multinational Quality of Life Cohort Study. Arthritis Rheum 57:35–43PubMedCrossRefGoogle Scholar
  9. 9.
    Amine B, Rostom S, Benbouazza K, Abouqal R, Hajjaj-Hassouni N (2009) Health related quality of life survey about children and adolescents with juvenile idiopathic arthritis. Rheumatol Int 29:275–279PubMedCrossRefGoogle Scholar
  10. 10.
    Feinstein AB, Forman EM, Masuda A, Cohen LL, Herbert JD, Moorthy LN et al (2001) Pain intensity, psychological inflexibility, and acceptance of pain as predictors of functioning in adolescents with juvenile idiopathic arthritis: a preliminary investigation. J Clin Psychol Med Settings 18:291–298CrossRefGoogle Scholar
  11. 11.
    Katsicas MM, Russo RG (2009) Use of adalimumab in patients with juvenile idiopathic arthritis refractory to etanercept and/or infliximab. Clin Rheumatol 28:985–988PubMedCrossRefGoogle Scholar
  12. 12.
    Tzaribachev N, Kuemmerle-Deschner J, Eichner M, Horneff G (2008) Safety and efficacy of etanercept in children with juvenile idiopathic arthritis below the age of 4 years. Rheumatol Int 28:1031–1034PubMedCrossRefGoogle Scholar
  13. 13.
    Bracaglia C, Buonuomo PS, Tozzi AE, Pardeo M, Nicolai R, Campana A et al (2012) Safety and efficacy of etanercept in a cohort of patients with juvenile idiopathic arthritis under 4 years of age. J Rheumatol 39:1287–1290PubMedCrossRefGoogle Scholar
  14. 14.
    Kingsbury DJ, Bader-Meunier B, Patel G, Arora V, Kalabic J, Kupper H (2014) Safety, effectiveness, and pharmacokinetics of adalimumab in children with polyarticular juvenile idiophatic arthritis aged 2 to 4 years. Clin Rheumatol. doi: 10.1007/s1006701424981 PubMedCentralGoogle Scholar
  15. 15.
    Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton 2001. J Rheumatol 31:390–392PubMedGoogle Scholar
  16. 16.
    Wallace C, Giannini E, Huang B, Itert L, Ruperto N (2011) American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res 63:929–936CrossRefGoogle Scholar
  17. 17.
    Iglesias E, Torrente-Segarra V, Bou R, Ricart S, González MI, Sánchez J et al (2014) Non-systemic juvenile idiopathic arthritis outcome after reaching clinical remission with anti-TNF-α therapy: a clinical practice observational study of patients who discontinued treatment. Rheumatol Int 34:1053–1057Google Scholar
  18. 18.
    Heijstek MW, Ott de Bruin LM, Bijl M, Borrow R, van der Klis F, Koné-Paut I et al (2011) EULAR recommendations for vaccination in paediatric patients with rheumatic diseases. Ann Rheum Dis 70:1704–1712PubMedCrossRefGoogle Scholar
  19. 19.
    Pileggi GS, de Souza CB, Ferriani VP (2010) Safety and immunogenicity of varicella vaccine in patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids. Arthritis Care Res (Hoboken) 62:1034–1039CrossRefGoogle Scholar
  20. 20.
    Silva CA, Aikawa NE, Bonfa E (2013) Vaccinations in juvenile chronic inflammatory diseases: an update. Nat Rev Rheumatol 9:532–543PubMedCrossRefGoogle Scholar
  21. 21.
    Mellins ED, Macaubas C, Grom AA (2011) Pathogenesis of systemic juvenile idiopathic arthritis: some answers, more questions. Nat Rev Rheumatol 7:416–426PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Clara Giménez-Roca
    • 1
    Email author
  • Estíbaliz Iglesias
    • 1
  • Vicenç Torrente-Segarra
    • 1
  • Rosa Bou
    • 1
  • Judith Sánchez-Manubens
    • 1
  • Joan Calzada-Hernández
    • 1
  • Samuel Hernández
    • 1
  • Sílvia Ricart
    • 1
  • Jordi Antón
    • 1
  1. 1.Unit of Pediatric Rheumatology, Department of PediatricsHospital Sant Joan de DéuEsplugues de LlobregatSpain

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