Evaluation of effectiveness and safety of Etanercept in children with Juvenile psoriatic arthritis

Introduction. Juvenile psoriatic arthritis is a chronic inflammatory disease accounting for 3-10% of all juvenile arthritis. Genetically engineered biological medications, particularly Etanercept, proved to be effective and safe in the adult patients with psoriatic arthritis; however, there are only a few studies on the use of Etanercept in children with juvenile psoriatic arthritis.

Objective. To evaluate the effectiveness and safety of Etanercept in children with juvenile psoriatic arthritis.

Children characteristics and research methods. This open, single-center, prospective, observational clinical study with observation period from 2012 to 2019 included 18 patients (2-13-year-old; mean age 7,58±3,7 years; boys/girls 2:1, average illness duration 3 [1,4-6,6] years with juvenile psoriatic arthritis; the patients received etanercept (0,8 mg/kg/week) in combination with methotrexate (10-15 mg/m²/week). The effectiveness was evaluated at the 6, 12 and 18th month. To assess the improvement in articular manifestations the authors applied the criteria of the American Association of Rheumatologists for pediatric patients (ACRpedi), to estimate the skin manifestations they used the BSA and PASI scores.

Results. In the test group by month 6 of study ACRpediNoResp/30/50/70/90/100 was 5,56/94,4/55,56/5,56/0/0%, by month 12 - 0/94,4/88,9/61,1/11,1/5,56%, by month 18 - 0/77,8/77,8/72,2/33,3/11,1% accordingly. Clinical and laboratory remission was recorded in 33,3% of cases. Drug-induced remission was 33,3%. The PASI score by months 6, 12, and 18 was 1,6 [0,6-4,6], 0,35 [0,1-1,05]; 0,1 [0-0,5], BSA - 4,9 [1,0-7,0], 1,5 [0,75-3,15] and 0,7[0,5-1,0] % respectively. 21,4% ofpatients demonstrated pharmacological remission of psoriasis. Drug-induced remission of psoriasis was 21,4%. There were no clinically significant adverse events during the study.

Conclusion. Thus, etanercept in combination with methotrexate has demonstrated its effectiveness against arthritis and psoriasis in children with juvenile psoriatic arthritis.

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