The frequency of infections in patients with juvenile idiopathic arthritis on biologic agents: 1-year prospective study
- 257 Downloads
The most effective and concurrently the safest treatment regimen selection is important to provide early control of juvenile idiopathic arthritis (JIA) and to have an acceptable quality of life. The effectivity of biologic agents as well as standard disease-modifying drugs is well documented in treatment of JIA. In spite of their high benefit, these drugs have the risk of serious infections. Herein, we conducted a prospective study to investigate the infectious complications of biologic agents in patients diagnosed with JIA.
Patients on biologic treatment regimen were examined by the pediatric infectious disease specialist in every 2 months during 1-year long.
Throughout the study period, 57% (n:175) of the patients developed infection and 43% (n:132) of them completed this period without any infection. Upper respiratory tract infections which were treated in outpatient clinic were the most common infection. Only three serious infections (two pneumonia, one pleural effusion), which required hospitalization, developed. The infection rate was highest in systemic JIA and lowest in enthesitis-related arthritis (p < 0.001). The total rate of infection development after 1-year period was lowest for etanercept; it was highest for the patients on infliximab treatment (p < 0.001).
We comment that the altered immune system of JIA can be responsible from the serious infections irrespective of immunosuppressive therapy. Biologic agents can be safely used in JIA evaluating the loss and benefit statement.
KeywordsBiologic agents Etanercept Infection Juvenile idiopathic arthritis
Compliance with ethical standards
The study protocol was in line with the guidelines of the 1975 Declaration of Helsinki. Ethics Committee approval was obtained from Faculty Local Ethics Committee (367966). Written informed consents were taken from all parents before commencing this study.
- 3.Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM et al (2011) American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res 63:465–482CrossRefGoogle Scholar
- 8.Lovell DJ, Reiff A, Jones OY, Schneider R, Nocton J, Stein LD, Gedalia A, Ilowite NT, Wallace CA, Whitmore JB, White B, Giannini EH, Pediatric Rheumatology Collaborative Study Group (2006) Long-term safety and efficacy of etanercept in children with polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum 54:1987–1994CrossRefGoogle Scholar
- 9.Lovell DJ, Reiff A, Ilowite NT, Wallace CA, Chon Y, Lin SL, Baumgartner SW, Giannini EH, Pediatric Rheumatology Collaborative Study Group (2008) Safety and efficacy of up to eight years of continuous etanercept therapy in patients with juvenile rheumatoid arthritis. Arthritis Rheum 58:1496–1504CrossRefGoogle Scholar
- 12.Beukelman T, Xie F, Baddley JW, Chen L, Delzell E, Grijalva CG, Mannion ML, Patkar NM, Saag KG, Winthrop KL, Curtis JR, on behalf of the SABER Collaboration (2013) Brief report: incidence of selected opportunistic infections among children with juvenile idiopathic arthritis. Arthritis Rheum 65:1384–1389CrossRefGoogle Scholar
- 13.Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P, International League of Associations for Rheumatology (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392Google Scholar
- 18.Lovell DJ, Ruperto N, Goodman S, Reiff A, Jung L, Jarosova K, Nemcova D, Mouy R, Sandborg C, Bohnsack J, Elewaut D, Foeldvari I, Gerloni V, Rovensky J, Minden K, Vehe RK, Weiner LW, Horneff G, Huppertz HI, Olson NY, Medich JR, Carcereri-de-Prati R, McIlraith M, Giannini EH, Martini A, Pediatric Rheumatology Collaborative Study Group, Pediatric Rheumatology International Trials Organisation (2008) Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N Engl J Med 359:810–820CrossRefGoogle Scholar
- 20.Horneff G, Burgos-Vargas R, Constantin T, Foeldvari I, Vojinovic J, Chasnyk VG et al (2014) Efficacy and safety of open-label etanercept on extended oligoarticular juvenile idiopathic arthritis, enthesitis-related arthritis and psoriatic arthritis: part 1 (week 12) of the CLIPPER study. Ann Rheum Dis 73:1114–1122CrossRefGoogle Scholar
- 21.Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O'Neil KM, Zeft AS, Szer IS, Ringold S, Brunner HI, Schanberg LE, Sundel RP, Milojevic D, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Hamilton S, Johnson A, Huang B, Lovell DJ, for the Childhood Arthritis and Rheumatology Research Alliance (2012) Trial of early aggressive therapy in polyarticular juvenile idiopathic arthritis. Arthritis Rheum 64:2012–2021CrossRefGoogle Scholar
- 22.Giannini EH, Ilowite NT, Lovell DJ, Wallace CA, Rabinovich CE, Reiff A, Higgins G, Gottlieb B, Singer NG, Pediatric Rheumatology Collaborative Study Group, Chon Y, Lin SL, Baumgartner SW (2009) Long-term safety and effectiveness of etanercept in children with selected categories of juvenile idiopathic arthritis. Arthritis Rheum 60:2794–2804CrossRefGoogle Scholar
- 23.Horneff G, Klein A, Klotsche J, Minden K, Huppertz HI, Weller-Heinemann F, Kuemmerle-Deschner J, Haas JP, Hospach A (2016) Comparison of treatment response, remission rate and drug adherence in polyarticular juvenile idiopathic arthritis patients treated with etanercept, adalimumab or tocilizumab. Arthritis Res Ther 18:272CrossRefGoogle Scholar
- 24.Davies R, Southwood TR, Kearsley-Fleet L, Lunt M, Hyrich KL, British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (2015) Medically significant infections are increased in patients with juvenile idiopathic arthritis treated with etanercept: results from the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study. Arthritis Rheum 67:2487–2494CrossRefGoogle Scholar