January 15, 2018
2 min read

Anti-TNF therapy effective against juvenile enthesitis-related arthritis

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Pamela F. Weiss

Anti-tumor necrosis factor therapy demonstrated greater benefits and clinical outcomes compared with conventional synthetic disease-modifying antirheumatic drugs in children with enthesitis-related arthritis the first year after diagnosis, according to findings published in the Journal of Rheumatology.

“Enthesitis-related arthritis accounts for 15% to 30% of juvenile idiopathic arthritis cases, depending on geographic region,” Pamela F. Weiss, MD, MSCE, of the Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, told Healio Rheumatology.

According to Weiss, less than 20% of children with enthesitis-related arthritis achieve remission within 5 years of diagnosis.

“The major impediment to advancing the care of children with [enthesitis-related arthritis] is scant evidence to guide physicians in the choice of one therapeutic agent or combination over another,” she said. “Clinicians not only need to know about the efficacy of [disease-modifying antirheumatic drugs] and biologics as stand-alone therapy vs. placebo, but also how they work in combination, and in comparison, to one another.”

To compare anti-TNF therapy to synthetic disease-modifying antirheumatic drugs in the treatment of enthesitis-related arthritis in children during the first year following diagnosis, the researchers conducted a multicenter retrospective study, estimating the effectiveness of each method on active joint count and tender entheses count, as well as self-reported pain and disease activity.

The researchers’ data included 217 children who had been recently diagnosed with enthesitis-related arthritis, representing 965 clinic visits. Among those patients, 33 received anti-TNF alone, 73 received only conventional synthetic disease-modifying antirheumatic drugs, and 52 were treated with both therapies during their first year.

According to the researchers, children who received anti-TNF treatment demonstrated a significant improvement in active joint count during their first year, compared with those who did not (P = .03). In addition, treatments that included anti-TNF exposure were associated with less patient-reported pain (P < .01), and improved Juvenile Arthritis Disease Activity Score (P < .01), compared with therapies that did not.

“Conventional [disease-modifying antirheumatic drug] therapy, as expected, also improved outcome measures,” Weiss said. “The magnitude of estimated effect, however, was uniformly greater in children treated with an anti-TNF drug vs. a conventional [disease-modifying antirheumatic drug].”

According to Weiss, the direction of the researchers’ estimates was consistent across all outcomes measures.

“This study supports the effectiveness of anti-TNF and [disease-modifying antirheumatic drug] medications the first year after [enthesitis-related arthritis] diagnosis in real life clinical care,” Weiss said. “... While this study may not provide the definitive answer to questions of comparative effectiveness for children with [enthesitis-related arthritis] as a clinical trial could, it can provide baseline estimates of the expected direction and size of treatment effect for alternative treatment regimens as they are used in the ‘real world’ without strict inclusion and exclusion criteria, and often in combination with other agents.” – by Jason Laday

Disclosure: The researchers report funding from the NIH and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.