Present day therapy of juvenile idiopathic arthritis with the use of genetically engineered medicines in a third level regional hospital - results and problems

Background. Juvenile idiopathic arthritis is accompanied by severe functional disabilities refractory to standard treatment with methotrexate. Recently introduced genetic engineering has significantly improved the functional state of the patients with persistent disease and stopped the progressive destruction of joints. However, the risk of adverse reactions against the background of this type of therapy requires further study. Aims: to analyze the efficiency of the genetically engineered drugs applied at juvenile arthritis and undesirable effects of this treatment. Materials and methods. Long-term (7 years) observations of 141 patients aged from 8 months to 18 with juvenile idiopathic arthritis. Results. The article summarizes the experience of successful application of genetically engineered biological preparations (tocilizumab, abatacept, etanercept, adalimumab) in 33 patients out of 141 patients with juvenile arthritis observed in Irkutsk. Serious infections were not registered, but we detected cases of managed neutropenia in 2 out of 12 patients receiving tocilizumab. In one case (3 %) out of 33 patients receiving genetically engineered drugs, the drug was withdrawn because of the risk of tuberculosis. Rare cases of secondary inefficiency of such drugs as abatacept, etanercept, adalimumab have been revealed. The tactics of treating children with undesirable reactions to genetically engineered drugs is described. Conclusions. Genetic engineering therapy has shown a good effect in improving clinical and functional indices and stopping joint destructive damage. However, when using genetically engineered drugs in treatment, the safety issues should be evaluated. Nevertheless, in our study there were no serious adverse events.

juvenile idiopathic arthritis, genetically engineered biological drugs, adverse events

1. Алексеева Е.И., Бзарова Т.М. Алгоритм диагностики и лечения ювенильного артрита // Вопросы современной педиатрии. - 2010. - Т. 9, № 6. - С. 78-104

2. Алексеева Е.И., Бзарова Т.М. Ювенильный артрит: возможности медикаментозного и немедикаментозного лечения на современном этапе // Лечащий врач. - 2011. - № 8. - С. 84-89

3. Баранов А.А., Алексеева Е.И., Валиева С.И., Бзарова Т.М., Денисова Р.В., Чистякова Е.Г., Слепцова Т.В., Митенко Е.В. Биологическая терапия в педиатрической ревматологии // Вопросы современной педиатрии. - 2011. - № 1. - С. 5-16

4. Баранов А.А., Алексеева Е.И. Детская ревматология. - М.: ПедиатрЪ, 2013. - 120 с

5. Boiu S, Marniga E, Bader-Meunier B, Mouy R, Compeyrot-Lacassagne S, Quartier P, Wouters CH. (2012). Functional status in severe juvenile idiopathic arthritis in the biologic treatment era: an assessment in a French paediatric rheumatology referral centre. Rheumatology, 51 (7), 1285-1292.

6. Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, Nam J, Ramiro S, Voshaar M, van Vollenhoven R, Aletaha D, Aringer M, Boers M, Buckley CD, Buttgereit F, Bykerk V, Cardiel M, Combe B, Cutolo M, van Eijk-Hustings Y, Emery P, Finckh A, Gabay C, Gomez-Reino J, Gossec L, Gottenberg JE, Hazes JMW, Huizinga T, Jani M, Karateev D, Kouloumas M, Kvien T, Li Z, Mariette X, McInnes I, Mysler E, Nash P, Pavelka K, Poor G, Richez C, van Riel P, Rubbert-Roth A, Saag K, da Silva J, Stamm T, Takeuchi T, Westhovens R, de Wit M, van der Heijde D. (2017). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis, 76 (6), 960-977.