Systemic Arthritis in Children: A Review of Clinical Presentation and Treatment

Table 2

Response to anti-TNF therapy in sJIA patients.

Study	Response	Number of patients	Discontinuation
Lovell et al. 2003 [169]; (per protocol group*); Etanercept	At 24 months: (i) JRA 30% definition of improvement seen in 83% of patients.; (ii) JRA 50% definition of improvement seen in 75% of patients.; (iii) JRA 70% definition of improvement seen in 67% of patients.	12	Not included
Lovell et al. 2003 [169] (modified intent-to-treat group**); Etanercept	At 24 months: (i) JRA 30% definition of improvement seen in 59% of patients.; (ii) JRA 50% definition of improvement seen in 53% of patients.; (iii) JRA 70% definition of improvement seen in 47% of patients.	17	5 (29%)
Horneff et al. 2004 [130]; Etanercept	At 1 month: (i) Giannini’s criteria of 30% improvement seen in 48% of patients.; (ii) Giannini’s criteria of 50% improvement seen in 33% of patients.; (iii) Giannini’s criteria of 70% improvement seen in 11% of patients.; At 3 months: (i) Giannini’s criteria of 30% improvement seen in 63% of patients.; (ii) Giannini’s criteria of 50% improvement seen in 39% of patients.; (iii) Giannini’s criteria of 70% improvement seen in 24% of patients.	66	17 (26%)
Kimura et al. 2005 [131]; Etanercept	Mean duration of treatment: 24.8±12.3 months (3–70 months): (i) Poor response (<30%) seen in 45% of patients.; (ii) Fair response (30 to <50%) in 9% of patients.; (iii) Good response (50 to <70%) seen in 13% of patients.; (iv) Excellent response (>70%) seen in 33% of patients.	82	29 (35%)
Russo and Katsicas 2009 [132]; Etanercept initially, if no improvement seen, infliximab or adalimumab were studied.	Treatment for at least 6 months: (i) ACR Pedi 30 seen in 78% of patients.; (ii) ACR Pedi 50 seen in 62% of patients.; (iii) ACR Pedi 70 seen in 47% of patients.; (iv) ACR Pedi 90 seen in 31% of patients.	45	22 (49%) of patients switched to a second anti-TNF (either infliximab-17 patients, or adalimumab-5 patients) secondary to lack of response in 9 pts and lack of efficacy subsequently. Infliximab was then discontinued in 4 patients secondary to lack of efficacy and in 6 patients secondary to toxicity.

*Per protocol group consisted of 43 patients (with pauciarticular, polyarticular or systemic JRA) who were treated with etanercept for 2 years at time of Lovell et al.’s analysis. Out of the 43 patients in this group, 12 patients had systemic JRA.
^{* *}Modified intent-to-treat group consisted of 51 patients (with pauciarticular, polyarticular or systemic JRA): 43 were included in the per protocol group, 7 withdrew secondary to an inadequate clinical response (of these, 4 had systemic JRA), and 1 withdrew secondary to an adverse reaction (that patient had systemic JRA). Out of the 51 patients in this group, 17 patients had systemic JRA.