The Efficacy of Combination Therapy by Adalimumab with Methotrexate and of Monotherapy by Methotrexate for Children Suffering from Polyarticular Juvenile Idiopathic Arthritis
https://doi.org/10.15690/vsp.v14i6.1475
Abstract
Background: The use of genetically engineered biological agents in patients with juvenile idiopathic arthritis (JIA) allows to achieve good results in treatment. However, their efficacy in patients refractory to basic antirheumatic drugs, requires further analysis.
Objective: To study the efficacy and safety of the combination therapy by adalimumab with methotrexate and of the monotherapy by methotrexate in children with JIA.
Methods: It was conducted a perspective (annual) comparative research with the analysis of the results of treating children with polyarticular seronegative JIA refractory to basic immunosuppressive therapy. The efficacy was assessed by ACRpedi criteria and by dynamics of values of cellular and humoral immunity indicators. Safety was determined by the number of adverse effects.
Results: The combination therapy by methotrexate with adalimumab for children with JIA (n = 14) in a shorter time than the monotherapy by methotrexate (n = 17) induced arthritis remission. After 46 weeks of treatment, the remission of arthritis and the normalization of laboratory findings were reported in 6 (43%) patients treated by adalimumab with methotrexate, and in 3 (18%) children — methotrexate (p = 0.233); adverse effects — in 4 (29%) and 14 (82%) cases (p = 0.004), respectively. No serious adverse effects have been registered.
Conclusion: The prescription of adalimumab in combination with methotrexate in children with JIA, refractory to basic immunosuppressive therapy, allows to achieve rapid remission of the disease while preserving the effect in a significant number of patients within 46 weeks of therapy.
About the Authors
V. A. Keltsev
Samara State Medical University, Samara, Russian Federation
Russian Federation
Russian Federation
L. I. Grebyonkina
Samara State Medical University, Samara, Russian Federation
Russian Federation
Russian Federation
Ye. D. Moiseeva
Samara State Medical University, Samara, Russian Federation
Russian Federation
Russian Federation
References
1. Cassidy JT, Petty RЕ Laxer RM, LindsleyС. В. Textbook of pediatric rheumatology. 6th edn. Philadelphia: Saunders Elsevier. 2011. 794 p.
2. Алексеева ЕИ, Литвицкий ПФ. Ювенильный ревматоидный артрит: этиология, патогенез, клиника, алгоритмы диагностики и лечения. М.: Веди. 2007. 368 с.
3. Алексеева ЕИ, Баранов АА. Руководство по биологической терапии. М. 2011. С. 247.
4. Кельцев ВА. Клиническая артрология (руководство для врачей). Самара: Содружество. 2010. 616 с.
5. Hashkes PJ, Laxer RM. Medical treatment of juvenile idiopathic arthritis. JAMA. 2005; 294:1671–1684.
6. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–778.
7. Schett G. Immune cells and mediators of inflammatory arthritis. Review. Autoimmunity. 2008;41:224–229.
8. Gabalawy HS, Lipsky RE. Why do we not have a cure for rheumatoid arthritis? Arthritis Res. 2004;4(2):297–301.
9. Horneff G. Update on biologicals for treatment of juvenile idiopathic arthritis. Exp Opin Biol. Ther. 2013;13(3):361–376.
10. Minden K, Niewerth M, Listing J, Lesting G. Long-term outcome in patients with juvenile rheumatoid arthritis. Arthritis Rheum. 2009;46:2392–2401.
11. Woo R, Wilkinson NR, Prieur AM, Ganser G. Open label phase 2 trial of single, ascending doses of MRA in Caucasian children with severe systemic juvenile idiopathic arthritis: proof of principle of efficacy of IL-6 receptor blocade in this type of arthritis and demonstration of prolonged clinical improvement. Arthritis Res Ther. 2005; 7:1281–1288.
12. Насонов ЕЛ, Каратеев ДЕ. Применение генно-инженерных биологических препаратов для лечения ревматоидного артрита: общая характеристика (лекция). Научно-практическая ревматология. 2013;51(2):163–169.
13. Каратеев ДЕ, Насонов ЕЛ, Лучихина ЕЛ. Эффективность и безопасность лечения адалимумабом больных активным ревматоидным артритом с резистентностью к стандартной терапии: результаты Российского национального исследования. Терапевтический архив. 2012;8:22–28.
14. Kingsbury DJ, Pierre Quartier DJ, Karunaratne PM, Kalabic J, Kupper H. Safety, effectiveness, and pharmacokinetics of adalimumabin children with polyarticular juvenile idiopathic arthritis aged 2 to 4 years. Clin Rheumatol. 2014. Doi: 10.1007/sl0067- 014-2498-l.
15. Ruperto N, Lovell DJ, Reiff A, Gamir M, Higgins G, Kone-Paut I, Jones OY, Chalom E, Ilowite N, Wouters C, Mcllraith MJ, Liu S, Kupper H, Giannini EH, Martini A. OLE DE038: Long-Term Efficacy and Safety of ADA for up to 6 years in Patients with JIA. ACR11. Arthritis Rheum. 2011;63(10). Abstr. 265.
16. Bradley JR. TNF-mediated inflammatory disease. J Pathol. 2012;214:149–160.
17. Ackermann C, Kavanaugh A. Tumor necrosis factor as a therapeutic target of rheumatologic disease. Exp Opin Ther Targets. 2010;11:1369–1384.
18. Tynjala P, Kotaniemi K, Lindahl P, Becker GC, Biom M. Adalimumab in juvenile idiopathic arthritis-associated chronic anterior uveitis. Rheumatology. 2010;47 (3):339–344.
19. Biester S, Deuter C, Michels H, Becker G. Adalimumab in the therapy of uveitis in childhood. Brit J Ophthalmol. 2007;9(3):319–324.
20. Лисицин АО, Алексеева ЕИ, Бзарова ТМ, Валиева СИ, Чомахидзе АМ, Исаева КБ. Опыт применения адалимумаба у больной юношеским полиартритом с поражением глаз. Вопросы современной педиатрии. 2008;7(5):115–120.
21. Денисова РВ, Алексеева ЕИ, Исаева КБ, Слепцова ТВ, Бзаро ва ТМ, Валиева СИ, Митенко ЕВ, Чистякова ЕГ, Чомахидзе AM, Фетисова АН, Ломакина ОЛ. Опыт применения адалимумаба у больного с системным ювенильным идиопатическим артритом. Вопросы современной педиатрии. 2013;12(6):123–129.
22. Кельцев ВА, Гребёнкина ЛИ, Моисеева ЕД. Сравнительная оценка эффективности и безопасности лечения адалимумабом в комбинации с меторексатом и монотерапии метотрексатом у детей с полиартикулярным ювенильным идиопатическим артритом в сочетании с увеитом. Вопросы современной педиатрии. 2014;13(6):60–66.
23. Алексеева ЕИ, Бзарова ТМ, Валиева СИ, Денисова РВ, Исаева КБ, Чистякова ЕГ, Чомахидзе АМ, Слепцова ТВ, Тайбулатов НИ, Фетисова АН, Шингарова МШ. Эффективность и безопасность длительного применения адалимумаба с иммунодепрессантами при ювенильном идиопатическом артрите без системных проявлений. Вопросы современной педиатрии. 2015;14(4):464–476.
Review
For citations:
Keltsev V.A., Grebyonkina L.I., Moiseeva Ye.D. The Efficacy of Combination Therapy by Adalimumab with Methotrexate and of Monotherapy by Methotrexate for Children Suffering from Polyarticular Juvenile Idiopathic Arthritis. Current Pediatrics. 2015;14(6):674-680. (In Russ.) https://doi.org/10.15690/vsp.v14i6.1475
Views:
1110
Email this article 
