TNF inhibitor improves outcomes in children with enthesitis-related arthritis
Use of antitumour necrosis factor (anti-TNF) therapy provides benefits for several clinically meaningful outcomes in children with enthesitis-related arthritis (ERA) during the first year after diagnosis, a study has shown.
A total of 965 clinic visits the first year after disease diagnosis were reported in 217 patients with ERA during the study period. Children (median age 11.6 years; interquartile range, 10‒14) received anti-TNF monotherapy (n=33; 15.2 percent), conventional synthetic disease-modifying antirheumatic drugs (csDMARD) monotherapy (n=73; 33.6 percent), or both (n=52; 23.9 percent) in the first year after ERA diagnosis.
Over time, children administered anti-TNF drug vs those who did not had a statistically significant improvement in active joint count (p=0.03). Anti-TNF therapy exposure vs no anti-TNF therapy also correlated with less patient-reported pain (p<0.01) and improved disease activity over time based on the clinical Juvenile Arthritis Disease Activity Score (p<0.01).
Furthermore, there was consistently greater magnitude of estimated effect on clinical outcomes in children treated with an anti-TNF drug vs csDMARD, except with tender entheses count.
The investigators conducted a multicentre retrospective comparative effectiveness study to describe the effect of ant-TNF therapy vs csDMARD in children diagnosed with ERA. They used state-of-the-art comparative effectiveness analytic methods to assess the effect of anti-TNF therapy on clinical variables (active joint count and tender entheses count) and patient-reported pain and global assessment of disease activity over the first year after diagnosis.
In a study that analysed and compared the effectiveness and drug survival in patients with rheumatoid arthritis of anti-TNF monotherapy, anti-TNF plus leflunomide, anti-TNF plus sulfasalazine, anti-TNF plus other csDMARD, and anti-TNF plus methotrexate (MTX) therapy in daily practice, researchers suggested that anti-TNF therapy should be prescribed together with MTX and if not possible, with other csDMARD. [J Rheumatol 2016;43:1787-1794]