Katsicas M M, Russo R A G
Service of Immunology, Hospital de Pediatría "Prof: Dr Juan P Garrahan", Buenos Aires, Argentina.
Clin Exp Rheumatol. 2005 Jul-Aug;23(4):545-8.
To analyse the effectiveness and safety of Infliximab in a group of patients with systemic juvenile idiopathic arthritis (SJIA) who had failed treatment with etanercept in a single paediatric rheumatology clinic.
Patients with SJIA with active polyarthritis refractory to methotrexate (MTX) [> or = 20 mg/m2/week] for at least 3 months and to etanercept (up to 1 mg/kg twice weekly) for at least 6 months were included. All children received infliximab 3-10 mg per kg of body weight intravenously concomitantly with MTX 7.5-10 mg/week for 19 (2-113) weeks. Evaluation included ACR paediatric 30 criteria and presence of signs of systemic activity (fever, rash).
Six patients were included. Three patients met ACR paediatric 30 criteria at 2 weeks (2 patients) and 10 weeks after initiation of infliximab. Improvement lasted for 4, 12, and 84 weeks respectively. The presence of fever/rash was not modified by the treatment. Infliximab was discontinued due to moderate side effects in 4 patients. No serious side effects were observed.
Most patients with SJIA who fail to respond to etanercept may not reach sustained improvement when switched to infliximab. The only patient in our group who improved sustainedly with infliximab did not show any systemic features at the beginning of therapy. Further controlled studies are needed in order to assess efficacy of infliximab in children with refractory SJIA.
分析英夫利昔单抗在一组系统性幼年特发性关节炎（SJIA）患者中的有效性和安全性，这些患者在一家儿科风湿病诊所接受依那西普治疗失败。
纳入对甲氨蝶呤（MTX）[≥20mg/m²/周]治疗至少3个月且对依那西普（每周两次，每次1mg/kg）治疗至少6个月仍有活动性多关节炎的SJIA患者。所有儿童静脉注射英夫利昔单抗3 - 10mg/kg体重，同时每周服用MTX 7.5 - 10mg，持续19（2 - 113）周。评估包括美国风湿病学会（ACR）儿科30标准以及全身活动体征（发热、皮疹）的存在情况。
纳入6例患者。3例患者在英夫利昔单抗治疗开始后2周（2例）和10周时达到ACR儿科30标准。改善分别持续了4周、12周和84周。治疗未改变发热/皮疹的存在情况。4例患者因中度副作用停用英夫利昔单抗。未观察到严重副作用。
大多数对依那西普无反应的SJIA患者改用英夫利昔单抗后可能无法实现持续改善。我们组中唯一使用英夫利昔单抗持续改善的患者在治疗开始时未表现出任何全身特征。需要进一步的对照研究来评估英夫利昔单抗在难治性SJIA儿童中的疗效。
