VALENCIA, SPAIN (EGMN) – Methotrexate may help prevent the development of uveitis in children with juvenile idiopathic arthritis, an etanercept registry study suggests.

Children who took a combination of methotrexate plus etanercept were significantly less likely to develop new-onset uveitis than were those who took etanercept as monotherapy, Dr. Ivan Foeldvari said at the congress of the Pediatric Rheumatology European Society.

“These data show indirectly if you give methotrexate, you prevent some cases of uveitis,” said Dr. Foeldvari of the Hamburg (Germany) Center for Child and Adolescent Rheumatology. Earlier data showed that before the widespread use of methotrexate, 30% of children with juvenile idiopathic arthritis (JIA) developed uveitis, whereas more recent data put that at 14%. “Considering that most of these patients now get methotrexate for their arthritis, you cannot [explain] this reduction otherwise,” observed Dr. Foeldvari.

Dr. Foeldvari and his colleagues reviewed the prevalence of uveitis in a subset of 868 patients in the German Etanercept Registry. The registry was launched in 2001 to track etanercept usage in children with JIA (Ann. Rheum. Dis. 2004;63:1638-44).

Dr. Foeldvari’s analysis included children who took etanercept monotherapy (74 children) and those who took etanercept plus methotrexate (246 children). Those taking etanercept in combination with other disease-modifying antirheumatic drugs were excluded (548 children).

The mean age of disease onset was 8.5 years, with mean disease duration of 4 years in the monotherapy group and 5 years in the combination therapy group. The mean duration of etanercept monotherapy was 1 year, and the mean duration of combination therapy was 2 years. Seven patients in the monotherapy group (9.5%) and 20 patients in the combination therapy group (8%) had already experienced a flare of uveitis before starting etanercept.

Over the course of treatment, new cases of uveitis developed in four of the monotherapy patients (5%) and in four who took methotrexate plus etanercept (1.6%). This translated to a rate of new-onset uveitis of 3.5 cases per 100 patients in the etanercept-only group, compared with 1 case per 100 patients in the combination therapy group.

Dr. Foeldvari also said that the time to onset of new uveitis was also significantly longer in the children on combination therapy than the monotherapy group, although he did not give a specific timeline.

Dr. Foeldvari has been on advisory boards for Abbott, Bristol-Myers Squibb, Essex Pharma GmbH, Roche, and Wyeth. The registry is funded by Wyeth.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

西班牙巴伦西亚(EGMN)——一项依那西普注册研究表明，甲氨蝶呤可用于预防幼年特发性关节炎(JIA)患儿葡萄膜炎。

 

Foeldvari博士及其同事对德国依那西普注册研究某一患者亚组(868例)的葡萄膜炎发病率进行了回顾性研究。该研究始于2001年，目的在于对JIA患儿依那西普用药情况进行跟踪研究。Foeldvari博士对单用依那西普(74例)和联用依那西普+甲氨蝶呤(246例)的患儿进行了分析，使用依那西普+其他改善病情抗风湿药的患儿(548例)被排除在外。患儿平均起病年龄为8.5岁。单药治疗组患儿平均病程为4年，平均用药时间为1年。联合用药组患儿平均病程为5年，平均用药时间为2年。开始服用依那西普前，单药治疗组和联合用药组分别有7例(9.5%)和20例(8%)已出现过葡萄膜炎发作。

 

结果显示，联合用药组患儿新发葡萄膜炎时间较单药组患儿显著更长，但具体时间不详。与单用依那西普的患儿相比，服用甲氨蝶呤+依那西普的患儿新发葡萄膜炎的风险显著降低。既往数据显示，在甲氨蝶呤得以广泛应用前，JIA患儿中有30%会出现葡萄膜炎，而近期数据表明，该数值已降至14%。考虑到大部分关节炎患者现在都加用甲氨蝶呤，且该药直到近期才被用作关节炎治疗的常规药物，可间接推断，甲氨蝶呤对葡萄膜炎具有预防效应。

 

Foeldvari博士曾在多家医药公司顾问委员会任职。该注册研究由惠氏公司资助。

 

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