Experience of use of the anti-cytokine drug adalimumab in children with polyarticular seronegative junior arthritis living in the Samara region

Background. Juvenile idiopathic arthritis is the most common rheumatic disease in childhood. Adalimumab is the drug of choice for polyarthritis, HLA-B27-associated arthritis, psoriatic arthritis, as well as for the association of arthritis with enthesitis, uveitis. It is of interest to evaluate the efficacy and safety of the genetically engineered biological drug adalimumab in patients with polyarticular rheumatoid factor seronegative juvenile idiopathic arthritis living in the Samara region.

Objective. The aim of the study is to evaluate the efficacy and safety of the genetically engineered biological drug adalimumab in patients with polyarticular seronegative juvenile idiopathic arthritis in the Russian Federation living in the Samara region.

Materials and methods. A retro- and prospective study of 32 (8 boys, 24 girls) patients with polyarticular juvenile idiopathic arthritis, seronegative in the Russian Federation, was carried out. The disease was diagnosed using the ILAR diagnostic criteria. The study was conducted from 2018 to 2022 on the basis of the Samara Regional Clinical Cardiological Dispensary V. P. Polyakov. Analysis of the effectiveness of the therapy was carried out during 6 visits with an interval of 70 days and included an assessment of the functional ability using the CHAQ questionnaire. The indicators of the effectiveness of therapy included: achievement of 50-90% improvement in drug remission of the disease.

Results. Efficacy, safety, and good tolerability of the anticytokine genetically engineered biological drug adalimumab in the treatment of children with polyarticular seronegative juvenile idiopathic arthritis in the Russian Federation have been proven.

Conclusion. The results obtained allow us to conclude that it is reasonable to use adalimumab in patients with refractoriness to immuno-suppressive therapy used for the treatment of juvenile arthritis and consider this approach promising in pediatric rheumatology.

1. Санталова Г. В., Плахотникова С. В., Шорохов С. Е.; ФГБОУ ВО СамГМУ Минздрава России. Современные аспекты диагностики и терапии ювенильного идиопатического артрита: учебное пособие. Самара: ООО «Порто-принт», 2021. 61 с. [Santalova G. V., Plakhotnikova S. V., Shorokhov S. E.; FSBEI IN SamSMU of the Ministry of Health of Russia. Modern aspects of diagnosis and therapy of juvenile idiopathic arthritis: a textbook. Samara: Porto-print LLC, 2021. 61 p. (In Russ.)]

2. Алексеева Е. И. Ювенильный идиопатический артрит: клиническая картина, диагностика, лечение. Вопросы современной педиатрии. 2015; 14 (1): 78-94. [Alekseeva E. I. Juvenile idiopathic arthritis: clinical picture, diagnosis, treatment. Voprosy sovremennoi pediatrii. 2015; 14 (1): 78-94. (In Russ.)]

3. Игишева Л. Н., Притчина С. С., Быкова Ю. А. и др. Ювенильные артриты: диагностика и лечение. МиД. 2017; 1: 48-61. [Igisheva L. N., Pritchina S. S., Bykova Yu. A., et al. Juvenile arthritis: diagnosis and treatment. MiD. 2017; 1: 48-61. (In Russ.)]

4. Zhou J., Ding Y., Zhang Y., et al. CD3+CD56+ natural killer T cell activity in children with different forms of juvenile idiopathic arthritis and the influence of etanercept treatment on polyarticular subgroup. Clin Immunol. 2017; 176: 1-11. DOI: 10.1016/j.clim.2016.12.001.

5. Ayaz N. A., Karadağ Ş. G., Çakmak F., et al. Leflunomide treatment in juvenile idiopathic arthritis. Rheumatol Int. 2019; 39 (9): 1615-1619. DOI: 10.1007/s00296-019-04385-7.

6. Adrovic A., Yildiz M., Haslak F., et al. Tocilizumab therapy in juvenile systemic sclerosis: a retrospective single centre pilot study. Rheumatol Int. 2021; 41 (1): 121-128. DOI: 10.1007/s00296-020-04732-z.

7. Баранов А. А., Алексеева Е. И., Валиева С. И. и др. Терапия генно-инженерными биологическими препаратами: эффективность и безопасность переключения. ВСП. 2014; 1. [Baranov A. A., Alekseeva E. I., Valieva S. I., et al. Therapy with genetically engineered biological drugs: efficiency and safety of switching. VSP. 2014; 1. (In Russ.)]

8. Vanoni F., Minoia F., Malattia C. Biologics in juvenile idiopathic arthritis: a narrative review. Eur J Pediatr. 2017; 176 (9): 1147-1153. DOI: 10.1007/s00431-017-2960-6.

9. Barut K., Adrovic A., Şahin S., et al. Juvenile Idiopathic Arthritis. Balkan Medical Journal. 2017; 34 (90). DOI: org/10.4274/balkanmedj.2017.0111.

10. Brunner H. I., Nanda K., Toth M., et al. Safety and Effectiveness of Adalimumab in Patients With Polyarticular Course of Juvenile Idiopathic Arthritis: STRIVE Registry Seven-Year Interim Results. Arthritis Care Res (Hoboken). 2020; 72 (10): 1420-1430. DOI: 10.1002/acr.24044.

11. Алексеева Е. И., Митенко Е. В., Валиева С. И. и др. Эффективность и безопасность терапии адалимумабом у детей с ювенильным идиопатическим артритом и увеитом. ВСП. 2012; 1. [Alekseeva E. I., Mitenko E. V., Valieva S. I., et al. Efficacy and safety of adalimumab therapy in children with juvenile idiopathic arthritis and uveitis. VSP. 2012; 1. (In Russ.)]

12. Гайдар Е. В., Костик М. М., Дубко М. Ф. и др. Эффективность адалимумаба при хроническом переднем увеите, ассоциированном с ювенильным идиопатическим артритом и резистентным к терапии метотрексатом: ретроспективное исследование серии случаев. ПФ. 2016; 4: 340-344. [Gaidar E. V., Kostik M. M., Dubko M. F., et al. The effectiveness of adalimumab in chronic anterior uveitis associated with juvenile idiopathic arthritis and methotrexate resistant to therapy: a retrospective study of a series of cases. PF. 2016; 4: 340-344. (In Russ.)]

13. Галстян Л. А., Жолобова Е. С., Старикова А. В. и др. Эффективность терапии абатацептом у пациентки с ювенильным идиопатическим артритом и двухсторонним увеитом. ВСП. 2016; 3: 307-310. [Galstyan L. A., Zholobova E. S., Starikova A. V., et al. The effectiveness of abatacept therapy in a patient with juvenile idiopathic arthritis and bilateral uveitis. VSP. 2016; 3: 307-310. (In Russ.)]

14. Петри А., Сэбин К. Наглядная статистика в медицине. М.: ГЭОТАР-МЕД, 2020. 232 с. [Petri A., Sabin K. Visual statistics in medicine. Moscow: GEOTAR-MED, 2020. 232 p. (In Russ.)]

15. Аксенов М. В., Пятых Е. А. Возможности использования генно-инженерных биологических препаратов в лечении ревматоидного артрита. Международный студенческий научный вестник. 2015; 2-3: 396-398. [Aksenov M. V., Pyatykh E. A. Possibilities of using genetically engineered biological preparations in the treatment of rheumatoid arthriti. Mezhdunarodnyi studencheskii nauchnyi vestnik. 2015; 2-3: 396-398. (In Russ.)]

16. Давыдова М. А. Развитие и прогноз деструктивных изменений суставов у детей с ювенильным идиопатическим артритом. Вопросы практической педиатрии. 2017; 12 (3): 46-53. [Davydova M. A. Development and prognosis of destructive changes in the joints in children with juvenile idiopathic arthritis. Voprosy prakticheskoi pediatrii. 2017; 12 (3): 46-53. (In Russ.)]

17. Давыдова М. А., Санталова Г. В., Стадлер Е. Р. и др. Динамика деструктивных изменений суставов при ювенильном идиопатическом артрите у детей, получавших метотрексат или комбинацию метотрексата и тоцилизумаба: результаты когортного исследования. Вопросы современной педиатрии. 2017; 16 (6): 502-508. [Davydova M. A., Santalova G. V., Stadler E. R., et al. Dynamics of destructive changes in the joints in juvenile idiopathic arthritis in children treated with methotrexate or a combination of methotrexate and tocilizumab: results of a cohort study. Voprosy prakticheskoi pediatrii. 2017; 16 (6): 502-508. (In Russ.)]

18. Малиевский В. А., Нижевич А. А., Первушина Е. П. и др. Опыт применения адалимумаба у больной ювенильным артритом с увеитом на фоне болезни Крона. Вопросы современной педиатрии. 2013; 4 (12): 181-184. [Malievsky V. A., Nizhevich A. A., Pervushina E. P., et al. Experience with the use of adalimumab in a patient with juvenile arthritis with uveitis associated with Crohn's disease. Voprosy prakticheskoi pediatrii. 2013; 4 (12): 181-184. (In Russ.)]