Use of infliximab in patients with systemic juvenile idiopathic arthritis refractory to etanercept.
Use of infliximab in patients with systemic juvenile idiopathic arthritis refractory to etanercept.
复制标题
英夫利昔单抗在依那西普难治性全身性幼年特发性关节炎患者中的应用。
DOI：
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发表时间：
2005
影响因子：
3.7
通讯作者：
R. Russo
中科院分区：
文献类型：
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作者：
M. Katsicas;R. Russo
目的
分析英夫利西单抗在一家儿科风湿病诊所接受依那西普治疗失败的全身性幼年特发性关节炎（SJIA）患者中的有效性和安全性。
方法
纳入了对甲氨蝶呤（MTX）[≥ 20 mg/m2/周]治疗至少3个月和对依那西普（高达1 mg/kg，每周两次）治疗至少6个月无效的活动性多关节炎SJIA患者。所有儿童均接受英夫利西单抗3-10 mg/kg体重静脉注射，同时接受MTX 7.5-10 mg/周，持续19（2-113）周。评价包括ACR儿科30标准和全身活动体征（发热、皮疹）的存在。
结果
纳入6例患者。3例患者在开始英夫利西单抗治疗后2周（2例患者）和10周时符合ACR儿科30标准。改善持续时间分别为4、12和84周。治疗未改变发热/皮疹的存在。4例患者因中度副作用而停用英夫利西单抗。未观察到严重副作用。
结论
大多数对依那西普治疗无效的SJIA患者在改用英夫利昔单抗治疗时可能无法获得持续改善。我们组中唯一一位在英夫利西单抗治疗后持续改善的患者在治疗开始时没有表现出任何全身特征。需要进一步的对照研究来评估英夫利西单抗在难治性SJIA儿童中的疗效。
OBJECTIVE
To analyse the effectiveness and safety of Infliximab in a group of patients with systemic juvenile idiopathic arthritis (SJIA) who had failed treatment with etanercept in a single paediatric rheumatology clinic.
METHODS
Patients with SJIA with active polyarthritis refractory to methotrexate (MTX) [> or = 20 mg/m2/week] for at least 3 months and to etanercept (up to 1 mg/kg twice weekly) for at least 6 months were included. All children received infliximab 3-10 mg per kg of body weight intravenously concomitantly with MTX 7.5-10 mg/week for 19 (2-113) weeks. Evaluation included ACR paediatric 30 criteria and presence of signs of systemic activity (fever, rash).
RESULTS
Six patients were included. Three patients met ACR paediatric 30 criteria at 2 weeks (2 patients) and 10 weeks after initiation of infliximab. Improvement lasted for 4, 12, and 84 weeks respectively. The presence of fever/rash was not modified by the treatment. Infliximab was discontinued due to moderate side effects in 4 patients. No serious side effects were observed.
CONCLUSIONS
Most patients with SJIA who fail to respond to etanercept may not reach sustained improvement when switched to infliximab. The only patient in our group who improved sustainedly with infliximab did not show any systemic features at the beginning of therapy. Further controlled studies are needed in order to assess efficacy of infliximab in children with refractory SJIA.