vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v17i2.1880vsp-1883Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLESРЕЗУЛЬТАТЫ ЛЕЧЕНИЯ ЭТАНЕРЦЕПТОМ ДЕТЕЙ С НЕСИСТЕМНЫМИ ВАРИАНТАМИ ЮВЕНИЛЬНОГО ИДИОПАТИЧЕСКОГО АРТРИТА: ДОСТИЖЕНИЕ РЕМИССИИ, РАЗВИТИЕ ОБОСТРЕНИЙ И НЕЖЕЛАТЕЛЬНЫХ ЯВЛЕНИЙ. РЕТРОСПЕКТИВНОЕ КОГОРТНОЕ ИССЛЕДОВАНИЕETANERCEPT TREATMENT RESULTS IN CHILDREN WITH NON-SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS: REMISSION, RECRUDESCENCE, AND ADVERSE EVENTS. RETROSPECTIVE COHORT STUDYhttps://orcid.org/0000-0002-1180-8086КостикМ. М.KostikMikhail M.

Костик Михаил Михайлович - доктор медицинских наук, доцент кафедры госпитальной педиатрии СПбГПМУ.

194100, Санкт-Петербург, ул. Литовская, д. 2,  тел.: +7 (812) 416-52-98

kost-mikhail@yandex.ruhttps://orcid.org/0000-0003-4636-5825ЧиковаИ. А.ChikovaIrina A.https://orcid.org/0000-0002-0911-7817ИсуповаЕ. А.IsupovaEugenia A.https://orcid.org/0000-0002-0579-3025ЛихачёваМ. Н.LikhachevaMaria N.https://orcid.org/0000-0002-0953-5453ЛихачёваТ. С.LikhachevaTatyana S.https://orcid.org/0000-0002-6834-1413ДубкоМ. Ф.DubkoMargaruta F.https://orcid.org/0000-0002-3703-4920МасаловаВ. В.MasalovaVera V.https://orcid.org/0000-0001-6778-4127СнегирёваЛ. С.SnegirevaLudmila S.https://orcid.org/0000-0002-0971-2018ГайдарЕ. В.GaidarEkaterina V.https://orcid.org/0000-0002-8683-4270КалашниковаО. В.KalashnikovaOlga V.https://orcid.org/0000-0001-5776-1490ЧасныкВ. Г.ChasnykVyacheslav G.Санкт-Петербургский государственный педиатрический медицинский университетРоссияSt. Petersburg State Pediatric Medical UniversityRussian Federation201822052018172138147Copyright © Костик М.М., Чикова И.А., Исупова Е.А., Лихачёва М.Н., Лихачёва Т.С., Дубко М.Ф., Масалова В.В., Снегирёва Л.С., Гайдар Е.В., Калашникова О.В., Часнык В.Г., 20182018Костик М.М., Чикова И.А., Исупова Е.А., Лихачёва М.Н., Лихачёва Т.С., Дубко М.Ф., Масалова В.В., Снегирёва Л.С., Гайдар Е.В., Калашникова О.В., Часнык В.Г.Kostik M.M., Chikova I.A., Isupova E.A., Likhacheva M.N., Likhacheva T.S., Dubko M.F., Masalova V.V., Snegireva L.S., Gaidar E.V., Kalashnikova O.V., Chasnyk V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/1883

Этанерцепт — биологический препарат, наиболее часто используемый у пациентов с ювенильным идиопатическим артритом (ЮИА). Результаты его применения продемонстрированы в многоцентровых и национальных исследованиях.

Цель исследования — оценить эффективность и безопасность применения этанерцепта у детей с несистемными вариантами ЮИА, определить предикторы достижения ремиссии и факторы риска развития обострений.

Методы

Методы. В ретроспективном когортном исследовании проанализированы результаты лечения (ремиссия, обострения, нежелательные явления) этанерцептом у детей с несистемными формами ЮИА. Минимальный период отслеживания исходов исследования — 6 мес.

Результаты

Результаты. Период ремиссии в течение 6–36 мес наступил у 77/131 (58,8%), обострения развились у 18/129 (14,0%) больных. Предикторами достижения ремиссии были возраст дебюта ЮИА < 8 лет [относительный риск (ОР) 2,05; 95% доверительный интервал (ДИ) 1,27–3,23], возраст назначения этанерцепта ≤ 10 лет (ОР 1,7; 95% ДИ 1,22–2,38), время болезни до назначения этанерцепта < 2,5 лет (ОР 2,4; 95% ДИ 1,4–4,4), наличие антигена HLA-B27 (ОР 2,15; 95% ДИ 0,98–4,75; р = 0,06). Риск обострений был выше у детей с полиартикулярным вариантом ЮИА (ОР 2,7; 95% ДИ 0,9–8,2; р = 0,08), тогда как использование метотрексата в терапии снижало риск обострений (ОР 0,32; 95% ДИ 0,1–1,15; р = 0,05). Этанерцепт по причине первичной (улучшение по критериям АКРпеди через 3 мес терапии < 30%) или вторичной (потеря ранее достигнутого ≥ 30% улучшения) неэффективности был отменен у 14/152 (9,2%) больных, увеит de novo развился у 8/152 (5,3%) пациентов, реакции в месте инъекции — у 6/152 (4,0%).

Заключение

Заключение. Терапия, включающая этанерцепт, с большей вероятностью индуцирует ремиссию у пациентов младшего возраста при дебюте ЮИА в возрасте до 8 лет и длительности анамнеза менее 2,5 лет. Высокий риск обострений отмечен у пациентов с полиартикулярным ЮИА, низкий — у получавших в составе комбинированной терапии метотрексат.

Background

Background. Etanercept is a biological drug most commonly used in patients with juvenile idiopathic arthritis (JIA). The results of its use are showed in local studies.

Objective

Objective. Our aim was to evaluate the efficacy and safety of the use of etanercept in children with non-systemic JIA, to determine the predictors of remission and the risk factors for the development of exacerbations.

Methods

Methods. In a retrospective cohort study, the results of etanercept treatment (remission, exacerbations, adverse events) in children with non-systemic JIA were analyzed. The minimum follow-up period was 6 months.

Results

Results. The period of remission within 6–36 months occurred in 77/131 (58.8%), exacerbations developed in 18/129 (14.0%) patients. Predictors of achieving remission were the age of JIA onset < 8 years [relative risk (RR) 2.05; 95% confidence interval (CI) 1.27–3.23], the age of prescribing etanercept ≤ 10 years (RR 1.7, 95% CI 1.22–2.38), the time of the disease prior to etanercept prescription < 2.5 years (RR 2.4, 95% CI 1.4–4.4), the presence of HLA-B27 antigen (RR 2.15, 95% CI 0.98–4.75; p = 0.06). The risk of exacerbations was higher in children with polyarticular JIA (RR 2.7, 95% CI 0.9–8.2; p = 0.08), whereas methotrexate therapy reduced the risk of exacerbations (RR 0.32, 95% CI 0.1–1.15; p = 0.05). Etanercept was discontinued due to primary (improvement by the ACRpedi criteria after 3 months of therapy <30%) or secondary (loss of previously achieved ≥ 30% improvement) failure in 14/152 (9.2%) patients; de novo uveitis developed in 8/152 (5.3%) patients; reactions at the injection site — in 6/152 (4.0%) patients.

Conclusion

Conclusion. Therapy involving etanercept is more likely to induce remission in younger patients with JIA onset at the age of 8 years and a history of less than 2.5 years. A high risk of exacerbations was noted in patients with polyarticular JIA, and low one — in those receiving methotrexate as a part of combined therapy.

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The authors declare that there are no conflicts of interest present.