Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Rheumatology (Oxford). 2013 Sep;52(9):1674-9. doi: 10.1093/rheumatology/ket170. Epub 2013 Jun 4.
To evaluate differences in baseline characteristics between etanercept- and adalimumab-treated JIA patients and to reveal factors that influence the choice between these TNF inhibitors, which are considered equally effective in the recent ACR recommendations for JIA treatment.
Biologic-naïve JIA patients with active arthritis who started treatment with adalimumab or etanercept between March 2008 and December 2011 were selected from the Dutch Arthritis and Biologicals in Children register. Baseline characteristics were compared. Focus group interviews with paediatric rheumatologists were performed to evaluate factors determining treatment choices.
A total of 193 patients started treatment with etanercept and 21 with adalimumab. Adalimumab-treated patients had longer disease duration prior to the start of biologics (median 5.7 vs 2.0 years) and more often a history of uveitis (71% vs 4%). Etanercept-treated patients had more disability at baseline (median Childhood Health Assessment Questionnaire score 1.1 vs 0.4) and more active arthritis (median number of active joints 6 vs 4). The presence of uveitis was the most important factor directing the choice towards adalimumab. Factors specific for the paediatric population-such as painful adalimumab injections-as well as the physician's familiarity with the drug accounted for the preference for etanercept.
Although the two TNF inhibitors are considered equally effective, in daily practice etanercept is most often prescribed; adalimumab is mainly preferred when uveitis is present. In choosing the most suitable biologic treatment, paediatric rheumatologists take into account drug and patient factors, considering newly published data and cautiously implementing this into daily care.
评估依那西普和阿达木单抗治疗幼年特发性关节炎（JIA）患者的基线特征差异，并揭示影响这两种 TNF 抑制剂选择的因素，这两种药物在最近的 ACR 推荐的 JIA 治疗中被认为同样有效。
从荷兰关节炎和儿童生物制剂登记处中选择了 2008 年 3 月至 2011 年 12 月期间开始接受阿达木单抗或依那西普治疗的生物初治 JIA 患者。比较了基线特征。对儿科风湿病专家进行焦点小组访谈，以评估确定治疗选择的因素。
共有 193 例患者开始接受依那西普治疗，21 例患者开始接受阿达木单抗治疗。阿达木单抗治疗组在开始生物制剂治疗前疾病持续时间较长（中位数 5.7 年 vs 2.0 年），且更常发生虹膜炎（71% vs 4%）。依那西普治疗组基线时残疾程度更高（中位数儿童健康评估问卷评分 1.1 分 vs 0.4 分），且更多的关节有活动性（中位数活动性关节数 6 个 vs 4 个）。虹膜炎的存在是选择阿达木单抗的最重要因素。儿科人群特有的因素-如阿达木单抗注射疼痛-以及医生对药物的熟悉程度，也解释了对依那西普的偏好。
尽管这两种 TNF 抑制剂被认为同样有效，但在日常实践中，依那西普更常被开处方；当存在虹膜炎时，主要选择阿达木单抗。在选择最合适的生物治疗时，儿科风湿病专家会考虑药物和患者因素，考虑新发表的数据，并谨慎地将其纳入日常护理中。
