Pontikaki Irene, Gerloni Valeria, Gattinara Maurizio, Luriati Alfredomaria, Salmaso Alessandra, De Marco Gabriele, Teruzzi Barbara, Valcamonica Elisabetta, Fantini Flavio
Unità Semplice di Reumatologia Infantile, Dipartimento e Cattedra di Reumatologia dell'Università di Milano.
Reumatismo. 2006 Jan-Mar;58(1):31-8.
To report adverse events registered in our population affected by JIA and treated with anti-TNFalpha blockers.
Ninety-five patients were enrolled to be treated with Etanercept, median age 14 years (range 4-34); median duration of therapy 12 months (range 1-40). 19 patients were also treated with MTX (median dose 12.5 mg/week). Fifty-six patients were enrolled to be treated with Infliximab associated with MTX (median dose of MTX 8.8 mg/week), median age 23.2 years (range 7.8-34.9); median duration of therapy 20.1 months (range 1.4-60.4). All adverse events were divided in definitely, probably and possibly related to the biologic agent.
Side effects definitely related to Infliximab were the reactions to infusions and the Anti-dsDNA positivity. Side effects definitely related to Etanercept were severe headache and thrombocytopenia. Side effects probably correlated to both the biological agents were behavioural modifications and pain amplification syndrome. Probably correlated to the treatment with Etanercept was the onset of Crohn's disease in 3 patients. Possibly correlated to the biological agents were the new onset or flare-up of Chronic Iridocyclitis and single cases of thyroideal cancer, hypoglossal nerve paralysis and a severe Cytomegalovirus pulmonary infection. No case of tuberculosis infection was registered during this study.
Treatment with a TNFalpha antagonist seems to be associated with various adverse events. Some of them, like onset of Crohn's disease, behavioural modifications are unusual and others, like pain amplification syndrome were never described before. Children and young adults affected by JIA should be monitored very carefully so as to limit as much as possible the risk of serious side effects on anti-TNFalpha therapy.
报告在我们的幼年特发性关节炎（JIA）患者群体中使用抗TNFα阻滞剂治疗时记录到的不良事件。
95例患者接受依那西普治疗，中位年龄14岁（范围4 - 34岁）；中位治疗持续时间12个月（范围1 - 40个月）。19例患者还接受了甲氨蝶呤（MTX）治疗（中位剂量12.5mg/周）。56例患者接受英夫利昔单抗联合MTX治疗（MTX中位剂量8.8mg/周），中位年龄23.2岁（范围7.8 - 34.9岁）；中位治疗持续时间20.1个月（范围1.4 - 60.4个月）。所有不良事件分为肯定、很可能和可能与生物制剂相关。
肯定与英夫利昔单抗相关的副作用是输液反应和抗双链DNA阳性。肯定与依那西普相关的副作用是严重头痛和血小板减少。很可能与两种生物制剂都相关的副作用是行为改变和疼痛放大综合征。3例患者克罗恩病的发作很可能与依那西普治疗相关。可能与生物制剂相关的是慢性虹膜睫状体炎的新发或复发以及甲状腺癌、舌下神经麻痹和严重巨细胞病毒肺部感染的个别病例。本研究期间未记录到结核感染病例。
TNFα拮抗剂治疗似乎与各种不良事件相关。其中一些，如克罗恩病的发作、行为改变并不常见，而其他一些，如疼痛放大综合征以前从未被描述过。受JIA影响的儿童和年轻人应进行非常仔细的监测，以尽可能降低抗TNFα治疗严重副作用的风险。
