Anti-Tumor Necrosis Factor Agents vs csDMARDs for Pediatric Enthesitis-Related Arthritis

In children with enthesitis-related arthritis, the use of anti-tumor necrosis factor (TNF) agents within the first year of diagnosis has demonstrated benefits in several clinically meaningful outcomes.

In children with enthesitis-related arthritis (ERA), the use of anti-tumor necrosis factor (TNF) agents within the first year of diagnosis demonstrated benefit in several clinically meaningful outcomes, according to results of a multicenter retrospective comparative efficacy study published in The Journal of Rheumatology.1

For this study, researchers compared the effects of anti-TNF therapy and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs)on several ERA-related outcomes, including active joint and tender entheses counts. Patient-reported pain and global assessment of disease activity were also assessed.

The study included 217 patients (mean age, 11.6; 71.9% boys; 83.4% white; arthritis, 86.2%; enthesitis, 66.4%) with newly diagnosed ERA who had a total of 965 outpatient clinic visits during the first year following disease diagnosis. Median symptom duration at baseline was 6 months. The participants received anti-TNF monotherapy (n=33; 15.2%), csDMARD monotherapy (n=73; 33.6%), or both (n=52; 23.9%).

A significant improvement in active joint count — the primary outcome — was observed over time in patients treated with an anti-TNF agent vs a csDMARD (P =.03). Anti-TNF therapy was associated with lower levels of patient-reported pain assessed with the visual analog scale (P <.01) and improved disease activity over time, as indicated by the clinical Juvenile Arthritis Disease Activity Score (P <.01). The magnitude of estimated effect on clinical outcomes was uniformly greater – with the exception of tender entheses count – in children who received anti-TNF therapy vs csDMARD.

Results from this study indicate the effectiveness of anti-TNF agents within the first year of ERA diagnosis in routine clinical practice. “Efficacy trials are critically needed of early [biologic] DMARD use vs traditional csDMARD to assess the effect on time to inactive disease, risk and treatment of sacroiliitis, patient-reported outcomes, and cost implications,” concluded the researchers.

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Weiss PF, Xiao R, Brandon TG, et al. Comparative effectiveness of tumor necrosis factor agents and disease-modifying antirheumatic therapy in children with enthesitis-related arthritis: the first year after diagnosis [published online September 15, 2017]. J Rheumatol. doi: 10.3899/jrheum.170251