Etanercept Safe and Effective for Treatment of Juvenile Psoriatic Arthritis

Treatment of juvenile psoriatic arthritis (JPsA) with etanercept was found to be safe and effective, exhibiting low rates of adverse events and positive treatment response,

according to results of an observational review published in RMD Open.

Accounting for 5% of juvenile idiopathic arthritis (JIA), JPsA is commonly treated with the biologic drug etanercept. Due to the low incidence of the disease, clinical data on treatment outcomes are limited. Researchers sought to evaluate the safety and efficacy of etanercept for treatment of patients with JPsA.

Data were taken from the Childhood Arthritis and Rheumatology Research Alliance Registry: an international database comprised of pediatric patients with rheumatic disease. Among approximately 70 clinical sites across North America, patients aged between 2 and 17 years with a diagnosis of JPsA who initiated treatment with etanercept were included in the analysis. Those with concurrent rheumatic disease treated with other biologics were excluded from the study.

Primary outcomes included drug safety (analyzed using 31 predetermined adverse events of special interest [AESIs]), drug efficacy (assessed by changes in the American College of Rheumatology [ACR]-Pediatric Response) and ACR provisional inactive disease criteria.

A total of 226 patients were included in the analysis, with 191 patients comprising the safety cohort and 43 patients comprising the effectiveness cohort. The patients from both cohorts were predominately White, girls, and had a median age at etanercept initiation of 10 years.

Patients in the safety cohort had a low incidence of AESIs, with 3 cases of nonserious uveitis, one new-onset neuropathy, and one malignancy, accounting for incidence rates of 0.55 (95% CI, 0.18-1.69), 0.18 (95% CI, 0.03-1.29), and 0.13 (95% CI, 0.02-0.90) per 100 person-years, respectively.

Of the15 patients in the effectiveness cohort reporting uninterrupted etanercept use at the 6-month follow-up, 80% showed an ACR30 response and 46.7% showed an ACR90 response. Similarly, of the 5 patients evaluated for ACR-Pediatric Response at the 12-month follow-up, 80% showed an ACR30 response and 20% showed an ACR90 response.

Of note, 34.1% and 20.6% of patients met ACR provisional criteria for clinically inactive disease at the 6-month and 12-month follow-up, respectively.

Study limitations included the small sample size and limited availability of clinical data. Additionally, no comparison group of patients who received treatments other than etanercept were included in the study. Finally, the study did not ascertain whether there were differences in treatment outcomes among patients with axial vs nonaxial peripheral JPsA.

The study authors stated, “These results inform treatment choice for JPsA, supporting the use of etanercept as a safe and effective treatment option in this disease setting, including in children under 12 years old, an age group for whom there is no drug approval.”

“No signals were observed to suggest that etanercept is less effective or safe in JPsA than JIA in general,” they concluded.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.