Etanercept for juvenile rheumatoid arthritis

Etanercept is a genetically engineered protein that slows or stops rheumatoid arthritis inflammation and joint damage. It has been studied and approved for use in treatment of children ages 4 to 17 who have juvenile rheumatoid arthritis (JRA).

Rheumatoid arthritis inflammation is caused in part by a substance called tumor necrosis factor (TNF) in the joint area; etanercept deactivates TNF.¹

Etanercept is used to treat moderate to severe rheumatoid arthritis symptoms and to prevent joint damage, particularly in people who have had side effects or poor results from methotrexate treatment.

When first approved for use, etanercept treatment was used only after methotrexate treatment had been unsuccessful. However, recent research suggests that etanercept works more quickly and more effectively prevents joint damage than methotrexate. (Long-term studies have yet to confirm whether etanercept prevents joint damage over a number of years.) As a result, the U.S. Food and Drug Administration (FDA) has approved etanercept for treating early stages of the disease.² It may be a treatment option for a child who has not responded to nonsteroidal anti-inflammatory drugs (NSAIDs).

Etanercept has shown positive preliminary results as a treatment for JRA-related inflammatory eye disease when combined with methotrexate and corticosteroid eyedrops.³

Etanercept:

• Improves joint pain and swelling as soon as 2 weeks from the beginning of treatment.
• In a recent preliminary study, etanercept improved symptoms in 80% of children with polyarticular JRA (polyarthritis). This improvement was maintained for 2 years after treatment began.⁴ In another study of children with severe, long-standing polyarticular JRA who have not been helped by methotrexate, etanercept provided symptom improvement that was sustained for at least 2 years (the period of the study).⁵
• Has shown promising results in safely improving vision in a small sample of children with JRA-related inflammatory eye disease (uveitis).³
• May not be an effective treatment for a child with systemic JRA.⁶
• Is not recommended for treating pauciarticular JRA.

Side effects of etanercept are usually minimal, including:⁶

• Irritation and redness at the injection site.
• Runny nose and cough (upper respiratory infection).
• Headache.
• Gastrointestinal symptoms.
• Rash.

Etanercept suppresses the immune system, making it difficult for the body to fight infection. Therefore, etanercept cannot be given to a person with an active viral or bacterial infection, nor within 3 months of a live-virus vaccine. If your child develops a sore throat, cough, fever, or skin or bladder infection, contact your child's health professional immediately.

Etanercept can reactivate tuberculosis (TB) in people who have been previously infected with TB. Before starting etanercept treatment, your child should be screened for tuberculosis.⁷ Screening is usually done with a tuberculin skin test and possibly a chest X-ray.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Etanercept treatment is very expensive.

Further study is needed to determine whether etanercept has any dangerous long-term effects.

Etanercept is not used to treat people with lupus or multiple sclerosis, based on rare reports of etanercept worsening these diseases.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Citations

1. Bathon JM, et al. (2000). A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. New England Journal of Medicine, 343(22): 1586–1593.

2. Klippel JH (2000). Biologic therapy for rheumatoid arthritis. New England Journal of Medicine, 343(22): 1640–1641.

3. Reiff A, et al. (2001). Etanercept therapy in children with treatment-resistant uveitis. Arthritis and Rheumatism, 44(6): 1411–1415.

4. Culy CR, Keating GM (2003). Spotlight on etanercept in rheumatoid arthritis, psoriatic arthritis, and juvenile rheumatoid arthritis. Biodrugs, 17(2): 139–145.

5. Lovell DJ, et al. (2003). Long-term efficacy and safety of etanercept in children with polyarticular-course juvenile rheumatoid arthritis. Arthritis and Rheumatism, 48(1): 218–226.

6. Wargula JC, Lovell DJ (2000). Use of etanercept in children. Bulletin on the Rheumatic Diseases, 49(12): 1–4.

7. Pisetsky DS, St Clair EW (2001). Progress in the treatment of rheumatoid arthritis. JAMA, 286(22): 2787–2790.

Author:	Shannon Erstad, MBA/MPH	Last Updated June 30, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Ross E. Petty, MD, PhD, FRCPC - Pediatric Rheumatology
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