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In the ETA cohort it was used in There were no important efficacy differences in first line or second line use of the 3 biologics. Drug survival rates of patients on monotherapy with a biologic compared to combination therapy with methotrexate revealed no significant difference. Conclusion: In clinical practice, ETA is the most frequently used as first biologic, ADA is used equally as first or second while TOC is used usually as a second or third line biologic.
Overall, tolerance was acceptable. Since patient cohorts differed at baseline these results are preliminary needwell controlled head to head studies for confirmation. Introduction: Juvenile idiopathic arthritis JIA is the most common rheumatic disease in childhood. Monoclonal anti-TNF drugs including adalimumab have been shown to induce formation of anti-drug antibodies ADA which are associated with reduced drug levels and higher disease activity in rheumatoid arthritis and inflammatory bowel diseases.
Secondary LOE was defined as any inflammatory joint activity after achieving remission. Other reasons for testing were arthralgia but no arthritis , severe local reaction and explicit parental request. Results: Main patient characteristics and descriptive statistics are summarized in the table below. Conclusion: In JIA patients, as seen in adult rheumatic disease as well, the formation of ADA against adalimumab obviously is a major factor causing reduced drug levels and secondary LOE.
The registry was set up to evaluate long term safety and efficacy of treatments in children with JIA. Methods: Retrospective and prospective evaluation of moderate to very severe and serious infections. The analysis of the impact of the single immunosuppressive drugs showed that the risk for infection is increased by corticosteroids OR 3.
The same results were observed for biologics, in particular rituximab OR Conversely, abatacept resulted protective OR 0. The multivariate results were confirmed by removing rituximab patients from the model.
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This risk is significantly enhanced by the addition of steroids to immunosuppressive therapy. We recommend monitoring for infections in JIA patients on immunosuppressive therapy. Swart: None Declared, G. Giancane: None Declared, F. Bovis: None Declared, E. Groll: None Declared, G. Huppertz: None Declared, D. Wolfs: None Declared, M. Hofer Consultant for: Novartis, E. Alekseeva: None Declared, V. Panaviene: None Declared, S. Nielsen: None Declared, J. Anton: None Declared, F. Uettwiller: None Declared, V.
Stanevicha: None Declared, M. Trachana: None Declared, D. Pires Marafon: None Declared, C. Ailioaie: None Declared, E. Tsitsami: None Declared, S. Kamphuis: None Declared, T. Herlin: None Declared, P. Susic: None Declared, B. Sztajnbok: None Declared, A. Pistorio: None Declared, A. This money has been reinvested for the research activities of the hospital in fully independent manners besides any commitment with third parties.
Wulffraat: None Declared, N. Risk factors for infections in JIA patients by multivariate analysis. REF: reference item. Introduction: Colchicine resistant and corticosteroid dependent unable to withdraw the drugs without relapse recurrent pericarditis is a major management challenge.
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Anakinra, an interleukin IL -1 beta recombinant receptor antagonist, is promising in this setting. Objectives: To determine the efficacy and safety of anakinra in colchicine resistant and corticosteroid dependent recurrent pericarditis in the first randomized controlled study. Methods: Investigator-initiated, double-blind, placebo 33 controlled, randomized withdrawal trial among 21 consecutive patients with colchicine resistant and corticosteroid dependent recurrent pericarditis enrolled in 3 Italian referral centers between June and November At enrolment, mean age was The primary outcomes were recurrent pericarditis and time to recurrence after randomization.
Conclusion: Anakinra is safe and efficacious to control and prevent recurrences in colchicine-resistant and corticosteroid-dependent patients with recurrent pericarditis. Trial registration identifying number: ClinicalTrials.
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Brucato: None Declared, M. Finetti: None Declared, G. Lazaros: None Declared, S. Maestroni: None Declared, M. Carraro: None Declared, D. Cumetti: None Declared, A. Carobbio: None Declared, M. Lorini: None Declared, A. Rimini: None Declared, R. Marcolongo: None Declared, A. Valenti: None Declared, G. Erre: None Declared, R. Belli: None Declared, F. Gaita: None Declared, M. Sormani: None Declared, N. Ruperto: None Declared, M. Imazio: None Declared, A. Martini: None Declared. Objectives: Report treatment failures and significant infectious side-effect, including deaths, in a cohort of patients with severe, refractory JIA referred for haematopoietic stem cell transplantation HSCT.
Methods: Data analysis from our centre, for the period All 4 deaths were caused by infections, 3 from central venous catheter related bacterial sepsis 1 during HSCT procedure, and 2 in patients receiving high-dose steroids, methotrexate and TNF-blocking biologics and 1 from disseminated adenovirus infection during HSCT procedure. Conclusion: Severe infections are emerging as an important mortality risk factor in children with severe, refractory JIA treated with combined and multiple immunosuppressive and anti-inflammatory therapies.
In this small group of patients, these risks should be carefully assessed towards the risks and potential benefits from allogeneic HSCT. Dismantling the pyramid. J Rheumatol Suppl Sandborg C, Mellins ED. A new era in the treatment of systemic juvenile idiopathic arthritis. N Engl J Med ; Abinun M et al.
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Autologous T cell depleted haematopoietic stem cell transplantation in children with severe juvenile idiopathic arthritis in the UK Moll Immunol ; Silva J et al. Allogeneic haematopoietic stem cell transplantation for systemic onset juvenile idiopathic arthritis. Prior to December , there was no national UK approval for the use of biologics in this older population, albeit they were used in adults with JIA.
Objectives: This mixed-methods study aimed to explore the clinical experience and decision-making of healthcare professionals in relation to the use of biologics in adults with JIA. Methods: Multi-method research was undertaken comprising of an online survey and one-to-one telephone interviews. The survey data was analysed using descriptive statistics and free-text comments using qualitative techniques; and the interview data was analysed qualitatively.
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This study had ethical approval with informed consent from all participants. Participants reported using all currently approved biologics for either JIA in children or rheumatoid arthritis; etanercept, adalimumab and tocilizumab being the most common. Factors influencing choice included: guidelines and funding; disease-associated factors; previous treatment; previous experience of clinician; and patient choice.
The terminology used for adult JIA diagnosis varied and was influenced by disease associated factors; previous diagnosis; and preferred treatment plan. The challenges encountered in treating adults with JIA included: access to biologic therapy; disease awareness; access to support from colleagues; problems associated with transitional care services; and patient expectations. Conclusion: Improved access to education and training as well as treatment guidelines relevant to the adult JIA context are likely to improve clinical experience and decision-making in relation to the management of adults with JIA.
Results: Overview. Of JIA pts enrolled, provided data for this. The total person-years p-y of observation were mean Wallace C, et al. Arthritis Care Res ; 63 — Filocamo G, et al.
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J Rheumatol ; 38 — Follow-up safety. A total of 30 AEs were seen 18 serious; all single occurrences in 25 pts 0. There were 12 infections of special interest 5. No new autoimmune diseases, deaths, malignancies or tuberculosis cases were reported. Abatacept was well tolerated and no new safety signals were seen. Tzaribachev: None Declared, A. Zeft: None Declared, R. Cimaz: None Declared, V. Stanevicha: None Declared, G. Bohnsack: None Declared, T.
Griffin: None Declared, R. Carrasco: None Declared, M. Trachana: None Declared, J. Dare: None Declared, I. Foeldvari: None Declared, R. Vehe: None Declared, F. Bovis: None Declared, T. Brunner: None Declared. Introduction: The advent of biologic medications has increased considerably the potential for treatment benefit in juvenile idiopathic arthritis JIA , with clinical remission being now achievable in a substantial proportion of patients.
However, there is a need of data from the real world of clinical practice to evaluate thoroughly the efficacy and safety profile of the biologic agents currently approved. Methods: This is a multicenter, observational study that includes all children with JIA who were given ETN at Italian pediatric rheumatology centers after January Patients in Group 1 underwent both retrospective and cross-sectional assessments, patients in Group 2 only retrospective assessments. ETN-related side effects were recorded in both groups. Results: A total of patients, in Group 1 and in Group 2 were enrolled in the study.
Median treatment duration was 2. In group 1, the frequency of inactive disease ID by Wallace criteria was In Group 2, reasons for ETN discontinuation included disease remission Serious adverse events were rare and were mostly represented by the development of inflammatory bowel diseases. Introduction: The goals of medical therapy of patients with Takayasu arteritis are to control active inflammation and to normalize clinical and laboratory parameters while preventing further vascular damage.
Corticosteroids and conventional immunosuppressive agents are not always safe or efficacious. The complex formed by interleukin-6 IL-6 and soluble IL-6 receptor appears to play a pivotal role in the pathogenesis of TA. Objectives: Herein, we report a child with TA to share the efficacy and safety of tocilizumab. Results: A- year old girl who fulfilled the classification criteria for TA was identified.
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Tak was 10 and ITAS was She consisting of thickening of the aortic arch, descending aorta and superior mesenteric artery wall, obstruction of the right main carotid artery and superior mesenteric artery failed to respond to corticosteroids, methotrexate, and cyclophosphamide. Corticosteroids were withdrawn, the patient's weight and height improved. Tak was 0. Conclusion: TA in children is a rare but potentially life-threatening condition.
The treatment of TA in children is weak, it is essential to treat TA aggressively as soon as the diagnosis is secured to reduce mortality and morbidity. Introduction: Systemic lupus erythematosus in children juvenile-onset SLE, jSLE has an unpredictable course and a more severe phenotype compared to adults. There are no standards for treatment of jSLE now. Several studies of B-cell targeted therapy with rituximab RTX in adults have demonstrated its high efficiency in various rheumatic diseases.
Robust data on the use of rituximab in jSLE are still lacking and dependent on small cohort studies. Objectives: To evaluate the efficacy and safety of rituximab in children with jSLE.