A new drug for treating children and
adolescents suffering from juvenile rheumatoid arthritis has been found to be
remarkably effective, according to a report published in The New England Journal
of Medicine.
Children who were given the drug etanercept had significant improvement in
their symptoms, and there were no signs of serious side effects, note Dr. Daniel
J. Lovell of Children's Hospital Medical Center in Cincinnati, Ohio, and
colleagues.
Rheumatoid arthritis causes the immune system to attack the body's own
tissues, causing joint swelling and pain. Between 30,000 to 50,000 children in
the United States have juvenile rheumatoid arthritis, according to statistics
published in 1998 in the journal Arthritis and Rheumatism.
About one third of all children suffering from the condition are treated
successfully with anti-inflammatory drugs and physical therapy, Lovell and
colleagues explain. But most patients need more aggressive therapy.
Many of them are treated with the drug methotrexate, which is effective and
well tolerated by children, though the frequency and severity of side effects
increase with higher doses of the drug.
"Although methotrexate can benefit patients with juvenile rheumatoid
arthritis, many do not have an adequate response to this drug, and there is
concern about long-term side effects," writes Dr. David S. Pisetsky of Duke
University Medical Center in Durham, North Carolina, in an accompanying
commentary. "The other options for disease-modifying therapy for children have
not been thoroughly tested. The availability of another safe and effective
medication for children with arthritis is therefore an important advance."
Etanercept is a genetically engineered drug that blocks a protein called
tumor necrosis factor, which plays a complex role in initiating inflammation
with rheumatoid arthritis.
In the study of patients aged 4 to 17 years, 81% of patients who received
(an inactive) placebo had a flare-up of the disease. In contrast, only 28% of
patients taking etanercept had flare-ups during the same time period.
"The significant clinical response supports the use of etanercept in
children with juvenile rheumatoid arthritis," Lovell and colleagues conclude.
