New Drug Helps Hard-to-Treat Kids With Arthritis
WebMD News Archive
March 15, 2000 (New York) -- Nearly three-quarters of children with deforming polyarticular juvenile rheumatoid arthritis taking a new type of arthritis drug had dramatic improvements in symptom relief, pain reduction, and ability to participate in school and play, according to the authors of a new report. Experts say it's important for parents of children whose symptoms are not alleviated by commonly used medications such as anti-inflammatory drugs or methotrexate to be aware of this option.
Juvenile rheumatoid arthritis (JRA) causes chronic swelling in areas such as the finger joints, wrist, and knees. In the polyarticular form of the disease, five or more joints are involved. Patients can have mild symptoms that disappear at puberty or severe ones that cause progressive, disabling arthritis. They often have intermittent flare-ups of the disease.
The exact cause of JRA is unknown, but it is thought to be due to infections or problems with the immune system. It is treated with medications that relieve symptoms and prevent long-term damage to the joints. Patients also may have physical therapy to preserve joint mobility.
The study, published in the March 16 issue of TheNew England Journal of Medicine, looked at 69 polyarticular JRA patients ages 4 to 17. It found that 74% benefited from the new drug, called Enbrel (etanercept). The medication worked quickly, with children showing marked improvements within weeks of taking it. "It seems to improve all aspects of the disease," lead researcher Daniel J. Lovell, MD, MPH, tells WebMD.
The study also found dramatic reductions in disease flare-ups and improvements in the length of time between flare-ups with Enbrel when compared to a placebo.
Enbrel is part of an emerging class of drugs known as tumor necrosis factor inhibitors. It works by blocking a protein believed to play a role in the inflammation common in rheumatoid arthritis. It must be given by injection twice weekly. Except for some reactions at the injection sites, the study reported no major side effects.
Lovell does not recommend Enbrel for the average kid with JRA because 60% of these children do well with anti-inflammatories or, failing that, with methotrexate.
"But parents should think about this drug if their kid has not responded to methotrexate or has shown only a partial response," says Lovell, of Children's Hospital Medical Center in Cincinnati. Lovell is chairman of the Pediatric Rheumatology Collaborative Study Group, which conducted the study in collaboration with the drug's manufacturer, Immunex.
"This is a very important drug so far as we can tell," Emily von Scheven, MD, assistant professor of pediatrics and rheumatologist at the University of California-San Francisco School of Medicine, tells WebMD. Von Scheven, who was not involved in the study, agrees with Lovell that the drug should only be used when other medications fail.
One downside to Enbrel is its expense. It costs about $1,000 a month, von Scheven tells WebMD. "While California Children's Services [the Medicare component for disabled children] has approved it," she says, "with other managed care organizations, it requires a pretty strong fight."