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Journal articles on the topic 'Juvenile idiopathic arthritis, adalimumab, immunogenicity'

Author: Grafiati

Published: 10 March 2023

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1

Doeleman, Martijn J. H., Erik M. van Maarseveen, and Joost F. Swart. "Immunogenicity of biologic agents in juvenile idiopathic arthritis: a systematic review and meta-analysis." Rheumatology 58, no. 10 (February 26, 2019): 1839–49. http://dx.doi.org/10.1093/rheumatology/kez030.

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Abstract Objective The clinical impact of anti-drug antibodies (ADAbs) in paediatric patients with JIA remains unknown. This systematic review and meta-analysis aimed to summarize the prevalence of ADAbs in JIA studies; investigate the effect of ADAbs on treatment efficacy and adverse events; and explore the effect of immunosuppressive therapy on antibody formation. Methods PubMed, Embase and the Cochrane Library were systematically searched to identify relevant clinical trials and observational studies that reported prevalence of ADAbs. Studies were systematically reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses and appropriate proportional and pairwise meta-analyses were performed. Results A total of 5183 references were screened; 28 articles, involving 26 studies and 2354 JIA patients, met eligibility criteria. Prevalence of ADAbs ranged from 0% to 82% across nine biologic agents. Overall pooled prevalence of ADAbs was 16.9% (95% CI, 9.5, 25.9). Qualitative analysis of included studies indicated that antibodies to infliximab, adalimumab, anakinra and tocilizumab were associated with treatment failure and/or hypersensitivity reactions. Concomitant MTX uniformly reduced the risk of antibody formation during adalimumab treatment (risk ratio 0.33; 95% CI 0.21, 0.52). Conclusion The association of ADAbs with treatment failure and hypersensitivity reactions indicates their clinical relevance in paediatric patients with JIA. Based on our findings, we recommend a preliminary course of action regarding immunogenicity of biologic agents in patients with JIA. Further strategies to predict, prevent, detect and manage immunogenicity could optimize treatment outcomes and personalize treatment with biologic therapies.

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Marzan, Katherine Anne B., and Andreas Otto Reiff. "Adalimumab in juvenile rheumatoid arthritis/juvenile idiopathic arthritis." Expert Review of Clinical Immunology 4, no. 5 (September 2008): 549–58. http://dx.doi.org/10.1586/1744666x.4.5.549.

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Magli, Adriano, Raimondo Forte, Pasqualina Navarro, Giustina Russo, Francesca Orlando, Loredana Latanza, and Maria Alessio. "Adalimumab for juvenile idiopathic arthritis-associated uveitis." Graefe's Archive for Clinical and Experimental Ophthalmology 251, no. 6 (March 1, 2013): 1601–6. http://dx.doi.org/10.1007/s00417-013-2275-x.

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Denisova, R. V., E. I. Alexeeva, K. B. Isaeva, T. V. Sleptsova, T. M. Bzarova, S. I. Valieva, E. V. Mitenko, et al. "ADALIMUMAB IN TREATMENT OF SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS." Current pediatrics 12, no. 6 (December 7, 2013): 123. http://dx.doi.org/10.15690/vsp.v12i6.887.

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Simpson, K., N. Marlow, J. Shaw, and А. V. Rudakova. "PHARMACOECONOMIC ISSUES OF ADALIMUMAB THERAPY IN JUVENILE IDIOPATHIC ARTHRITIS." Pediatric pharmacology 9, no. 4 (August 12, 2012): 48. http://dx.doi.org/10.15690/pf.v9i4.390.

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Ramanan, Athimalaipet V., Andrew D. Dick, Ashley P. Jones, Andrew McKay, Paula R. Williamson, Sandrine Compeyrot-Lacassagne, Ben Hardwick, et al. "Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis." New England Journal of Medicine 376, no. 17 (April 27, 2017): 1637–46. http://dx.doi.org/10.1056/nejmoa1614160.

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Tynjala, P., K. Kotaniemi, P. Lindahl, K. Latva, K. Aalto, V. Honkanen, and P. Lahdenne. "Adalimumab in juvenile idiopathic arthritis-associated chronic anterior uveitis." Rheumatology 47, no. 3 (November 28, 2007): 339–44. http://dx.doi.org/10.1093/rheumatology/kem356.

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Aksenov, A. V., and E. A. Ivanovskaya. "Successful Use of Adalimumab in Children with Uveitis-Associated Juvenile Idiopathic Arthritis." Doctor.Ru 20, no. 10 (2021): 73–75. http://dx.doi.org/10.31550/1727-2378-2021-20-10-73-75.

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Objective of the Paper: To describe clinical cases of successful use of adalimumab in children with uveitis-associated juvenile idiopathic arthritis (JIA). Key Points. One of the extraarticular manifestations of JIA is uveitis, i. e. inflammation of the vascular tract of the eye. JIA-associated uveitis is diagnosed primarily in small girls with oligoarthritis, early seronegative polyarthritis; in patients with arthritis associated with enthesitis and psoriatic arthritis. The article describes clinical cases of the use of adalimumab in JIA and uveitis where the therapy with methotrexate and topical glucocorticosteroids fails. Conclusion. Uveitis-associated JIA is one of the most disabling forms of JIA, since, despite timely and adequate management, very often it results in severe ocular complications: cataract, glaucoma and even blindness. Adalimumab, a human anti-TNFα monoclonal antibody, is available and it helps in achieving uveitis remission where methotrexate and topical glucocorticosteroids fail, as well as in delaying ocular complications. Keywords: juvenile idiopathic arthritis, uveitis, adalimumab, children.

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Chen, Judy L., Parinaz Abiri, and Edmund Tsui. "Recent advances in the treatment of juvenile idiopathic arthritis–associated uveitis." Therapeutic Advances in Ophthalmology 13 (January 2021): 251584142098457. http://dx.doi.org/10.1177/2515841420984572.

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Juvenile idiopathic arthritis–associated uveitis has an estimated prevalence of 10–20% in patients with juvenile idiopathic arthritis, making it the most common cause of chronic anterior uveitis in children. Prompt treatment is important to prevent development of ocular complications and permanent vision loss. In this review, we will discuss the use of immunosuppression in treatment of juvenile idiopathic arthritis–associated uveitis. This will include the use of conventional immunosuppressants, such as methotrexate, biologic anti-tumor necrosis factor agents, such as adalimumab, as well as other anti-tumor necrosis factor agents, including infliximab and golimumab. In addition, we will discuss medications currently in clinical trials or under consideration for juvenile idiopathic arthritis–associated uveitis, including interleukin-6 inhibitors (tocilizumab) and Janus kinase inhibitors (tofacitinib, baricitinib).

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Thorne, Jennifer E. "Adalimumab in the Treatment of Uveitis in Juvenile Idiopathic Arthritis." New England Journal of Medicine 376, no. 17 (April 27, 2017): 1682–83. http://dx.doi.org/10.1056/nejme1701811.

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Biswas, Jyotirmay, Harshit Vaidya, and Parthopratim Dutta Majumder. "Presumed tubercular choroidal nodule following adalimumab therapy for juvenile idiopathic arthritis." Indian Journal of Ophthalmology 67, no. 3 (2019): 399. http://dx.doi.org/10.4103/ijo.ijo_1149_18.

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Munera-Campos, Mónica, Asunción Vicente, Laura Rosende, and Carlota Rovira. "Lichen nitidus in a child receiving adalimumab for juvenile idiopathic arthritis." Indian Journal of Dermatology, Venereology and Leprology 87 (February 24, 2021): 408–9. http://dx.doi.org/10.25259/ijdvl_241_19.

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Clement, Ana, Isabel Valls, Belen Gutierrez, and Clara Jimenez. "050: Adalimumab in the therapy of juvenile idiopathic arthritis-associated uveitis." Journal of American Association for Pediatric Ophthalmology and Strabismus 13, no. 1 (February 2009): e13. http://dx.doi.org/10.1016/j.jaapos.2008.12.021.

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Miyamae, Takako, Takuma Hara, Aki Hanaya, Yumi Tani, Takayuki Kishi, and Hisashi Yamanaka. "Effect of Adalimumab on Refractory Arthritis in Juvenile Idiopathic Inflammatory Myopathy with Anti-MDA5 Autoantibody." Case Reports in Rheumatology 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/2164312.

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A 10-year-old girl manifested persistent fever, skin rash, leg pain, fatigue, and joint pain. Based on muscle weakness, elevated muscle-derived enzymes, magnetic resonance imaging, and skin biopsy results, the diagnosis was juvenile idiopathic inflammatory myopathies (JIIM). Chest CT was normal; the anti-melanoma differentiation-associated protein-5 (anti-MDA5) autoantibody was positive. Initial manifestations subsided after prednisolone (PSL) and methotrexate treatment. After the PSL dosage was decreased, the patient presented with metacarpophalangeal (MCP) joint pain and swelling in both index fingers, synovial fluid, and signals on power Doppler ultrasound. The arthritis was refractory to cyclosporine and tacrolimus. Radiography showed progressive MCP joint space narrowing and joint erosion. Adalimumab was initiated 14 months after disease onset. There was a mildly increased matrix metalloproteinase-3 (MMP3) level, an erythrocyte sedimentation ratio (ESR), and a normal CRP level. Adalimumab resulted in decreased MCP joint pain and swelling. PSL was discontinued 10 months after adalimumab initiation; after 9 more months of adalimumab, there were no significant ultrasonography findings. MMP3 and ESR levels normalized during treatment. Radiography after 2 years of adalimumab showed further progressive MCP joint space narrowing restricting dorsiflexion. This report clarified that anti-MDA5-positive JIIM joint manifestations were due to active synovitis and that adalimumab is required for severe cases. Further experience is needed to determine the pathology, severity, and prognosis of this type of arthritis.

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Matsuo, Toshihiko, and Masato Yashiro. "Long-Term Control of Macular Edema With Adalimumab After Cataract Surgery in a Japanese Child With Juvenile Idiopathic Arthritis: Case Report and Review of 26 Japanese Patients." Journal of Investigative Medicine High Impact Case Reports 8 (January 2020): 232470962095328. http://dx.doi.org/10.1177/2324709620953283.

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Juvenile idiopathic arthritis–associated uveitis is rare in the Japanese population. In this article, we report a child whose macular edema was controlled for years after cataract surgery with adalimumab, and reviewed 26 Japanese patients in the literature. In this case report, a 4-year-old boy developed band keratopathy, posterior iris synechiae, and complicated cataract in both eyes. Oral prednisolone prescribed at another hospital was discontinued due to high intraocular pressure in both eyes as a steroid responder. At the age of 5 years, he started oral methotrexate 8 mg weekly for recurrent bilateral iridocyclitis and then underwent lensectomy with core vitrectomy in both eyes. Planned intraocular lens implantation was cancelled at surgery because the anterior vitreous had severe inflammatory opacity with diffuse retinal edema in both eyes. Due to persistent macular edema in both eyes 5 months postoperatively, at the age of 6 years, he began to use adalimumab injection 20 mg every 2 weeks. The macular structure depicted by optical coherence tomography became normal in 2 months. At final visit at the age of 11 years, he had the best-corrected visual acuity of 0.8 in the right eye and 0.4 in the left eye, with adalimumab 40 mg every 2 weeks and methotrexate 8 mg weekly. In conclusion, macular edema persistent despite oral methotrexate after cataract surgery could be controlled for long term by adalimumab in a child with juvenile idiopathic arthritis. In the Japanese literature, only 26 additional cases with juvenile idiopathic arthritis–associated uveitis have been reported so far.

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Sevostyanov, V. K., N. V. Babich, E. P. Kakorina, and E. S. Zholobova. "Cost effectiveness of biologicals in the treatment of juvenile idiopathic arthritis." Voprosy praktičeskoj pediatrii 17, no. 1 (2022): 53–60. http://dx.doi.org/10.20953/1817-7646-2022-1-53-60.

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Objective. To evaluate cost effectiveness of biologicals in the treatment of juvenile idiopathic arthritis (JIA) to plan financial resources and purchases of high-cost medicines. Materials and methods. We performed clinical and economic analysis of biologicals used in patients with polyarticular JIA (pJIA) and systemic JIA (sJIA) using the methods of cost minimization and cost effectiveness. Results. The lowest annual treatment costs for pJIA were observed in children aged <5 years and 6–11 years receiving tocilizumab and etanercept. Among patients aged 12–17 years, the lowest treatment costs were registered in those receiving adalimumab and etanercept. Etanercept and tocilizumab were the least expensive drugs used in children with sJIA aged <5 years and 6–11 years, whereas in sJIA patients aged 12–17 years, therapy with adalimumab and etanercept was associated with the lowest costs. Similar results were obtained in the analysis of cost effectiveness. Conclusion. Our findings should be used for cost optimization of therapy with biologicals for JIA patients from different age groups. This will increase the availability of expensive therapy, reduce the risk of disability, and preserve their ability to work in the future. However, the main criteria for choosing a drug should certainly be the disease phenotype and its manifestations. Key words: juvenile arthritis, biologicals, cost-effectiveness analysis

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Tsulukiya, I., E. Alexeeva, T. Dvoryakovskaya, R. Denisova, A. Mamutova, K. Isaeva, A. Chomakhidze, et al. "POS1322 DISCONTINUATION OF LONG-TERM ADALIMUMAB TREATMENT IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS-ASSOCIATED UVEITIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 998.1–998. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4766.

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BackgroundUveitis is the most common extra-articular manifestation of JIA which may lead to sight-threatening ocular complications. Topical corticosteroids are still used in the initial treatment for JIA-associated uveitis. The goal of treatment in these patients should be topical corticosteroid-free remission and prevention of recurrences. The most commonly used corticosteroid-sparing immunomodulatory are TNF-α inhibitors (TNFi), especially adalimumab.Currently, limited data are available about when or how to stop adalimumab when remission of JIA-associated uveitis is presumed.ObjectivesTo evaluate rates of relapse after discontinuation adalimumab in patients with JIA-associated uveitis.MethodsMedical records of 33 patients with JIA-associated uveitis who were successfully treated with adalimumab to a state of topical corticosteroid-free remission and discontinued adalimumab due to a long-term remission were analyzed retrospectively.Remission of uveitis was defined as <1+ cells in the anterior chamber and <1 + vitreous haze grading; relapse was defined as ≥1 cell in the anterior chamber or ≥1 vitreous haze grading [1].ResultsCorticosteroid-sparing control of inflammation was achieved in all patients. Adalimumab was discontinued after 50 (range 12–120) months after initiation of adalimumab. Duration of remission prior to discontinuing adalimumab was 42 (range 6 – 114) months. The mean duration of remission after adalimumab discontinuation was 14 (range 1–59) months. 13 (40%) of patients had flares after less than 12 months after discontinuing adalimumab, 5 (15%) had flares after 12 – 24 months, 15 (45%) had not flared due to 24 months after discontinuation adalimumab and had had a long-term non-biological remission. Disease was successfully controlled in 11(33%) patients with non-biological DMARDs, 22 (66%) patients restarted biological therapy after flares, due to lack of improvement after non-biological DMARDs. All patients in whom biological therapy was reinitiated responded satisfactorily. None of the flared patients didn’t require restarting corticosteroids.ConclusionCorticosteroid-sparing control of inflammation was achieved in all patients. Data from our experience with adalimumab in patients with JIA-associated uveitis suggest that 45 % of patients can be successfully withdrawn from biologics for at least 24 months without disease recurrence.References[1]Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop. Am J Ophthalmol 2005;140: 509-16.Disclosure of InterestsIrina Tsulukiya: None declared, Ekaterina Alexeeva Speakers bureau: Speaker for Roche, AbbVie, Bristol-Myers, Squibb, MSD, Novartis and Pfizer., Grant/research support from: Financial grants from Roche, Pfizer, Centocor, Eli Lilly, AbbVie, Bristol-Myers Squibb, MSD, Sanofi, Amgen and Novartis., Tatyana Dvoryakovskaya Speakers bureau: Speaker for Roche, AbbVie, Bristol-Myers, Squibb, MSD, Novartis and Pfizer., Grant/research support from: Financial grants from Roche, Pfizer, Centocor, Eli Lilly, AbbVie, Bristol-Myers Squibb, MSD, Sanofi, Amgen and Novartis., Rina Denisova Speakers bureau: Speaker for Roche, AbbVie, MSD, Novartis., Grant/research support from: Financial grants from Roche, Pfizer, Centocor, Sanofi and Novartis., Anna Mamutova Speakers bureau: Speaker for Novartis., Grant/research support from: Financial grants from Eli Lilly., Ksenia Isaeva Grant/research support from: Financial grants from Roche, Novartis and Sanofi., Aleksandra Chomakhidze: None declared, Olga Lomakina Grant/research support from: Financial grants from Pfizer, Eli Lilly., Anna Fetisova Grant/research support from: Financial grants from Amgen., Marina Gautier: None declared, Kristina Chibisova: None declared, Ivan Kriulin Speakers bureau: Speaker for Novartis., Elizaveta Krekhova Speakers bureau: Speaker for Novartis., Maria Botova: None declared

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Ramanan, Athimalaipet V., Andrew D. Dick, Ashley P. Jones, Dyfrig A. Hughes, Andrew McKay, Anna Rosala-Hallas, Paula R. Williamson, et al. "Adalimumab in combination with methotrexate for refractory uveitis associated with juvenile idiopathic arthritis: a RCT." Health Technology Assessment 23, no. 15 (April 2019): 1–140. http://dx.doi.org/10.3310/hta23150.

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Background Children with juvenile idiopathic arthritis (JIA) are at risk of uveitis. The role of adalimumab (Humira®; AbbVie Inc., Ludwigshafen, Germany) in the management of uveitis in children needs to be determined. Objective To compare the efficacy, safety and cost-effectiveness of adalimumab in combination with methotrexate (MTX) versus placebo with MTX alone, with regard to controlling disease activity in refractory uveitis associated with JIA. Design This was a randomised (applying a ratio of 2 : 1 in favour of adalimumab), double-blind, placebo-controlled, multicentre parallel-group trial with an integrated economic evaluation. A central web-based system used computer-generated tables to allocate treatments. A cost–utility analysis based on visual acuity was conducted and a 10-year extrapolation by Markov modelling was also carried out. Setting The setting was tertiary care centres throughout the UK. Participants Patients aged 2–18 years inclusive, with persistently active JIA-associated uveitis (despite optimised MTX treatment for at least 12 weeks). Interventions All participants received a stable dose of MTX and either adalimumab (20 mg/0.8 ml for patients weighing < 30 kg or 40 mg/0.8 ml for patients weighing ≥ 30 kg by subcutaneous injection every 2 weeks based on body weight) or a placebo (0.8 ml as appropriate according to body weight by subcutaneous injection every 2 weeks) for up to 18 months. A follow-up appointment was arranged at 6 months. Main outcome measures Primary outcome – time to treatment failure [multicomponent score as defined by set criteria based on the Standardisation of Uveitis Nomenclature (SUN) criteria]. Economic outcome – incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the NHS in England and Personal Social Services providers. Full details of secondary outcomes are provided in the study protocol. Results A total of 90 participants were randomised (adalimumab, n = 60; placebo, n = 30). There were 14 (23%) treatment failures in the adalimumab group and 17 (57%) in the placebo group. The analysis of the data from the double-blind phase of the trial showed that the hazard risk (HR) of treatment failure was significantly reduced, by 75%, for participants in the adalimumab group (HR 0.25, 95% confidence interval 0.12 to 0.51; p < 0.0001 from log-rank test). The cost-effectiveness of adalimumab plus MTX was £129,025 per QALY gained. Adalimumab-treated participants had a much higher incidence of adverse and serious adverse events. Conclusions Adalimumab in combination with MTX is safe and effective in the management of JIA-associated uveitis. However, the likelihood of cost-effectiveness is < 1% at the £30,000-per-QALY threshold. Future work A clinical trial is required to define the most effective time to stop therapy. Prognostic biomarkers of early and complete response should also be identified. Trial registration Current Controlled Trials ISRCTN10065623 and European Clinical Trials Database number 2010-021141-41. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 15. See the NIHR Journals Library website for further project information. This trial was also funded by Arthritis Research UK (grant reference number 19612). Two strengths of adalimumab (20 mg/0.8 ml and 40 mg/0.8 ml) and a matching placebo were manufactured by AbbVie Inc. (the Marketing Authorisation holder) and supplied in bulk to the contracted distributor (Sharp Clinical Services, Crickhowell, UK) for distribution to trial centres.

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Galstyan, L. A., E. S. Zholobova, O. S. Razvadovskaya, A. V. Bunin, and A. V. Starikova. "EFFICACY OF ADALIMUMAB IN A PATIENT WITH JUVENILE IDIOPATHIC ARTHRITIS AND UVEITIS." Current pediatrics 11, no. 6 (November 19, 2012): 142. http://dx.doi.org/10.15690/vsp.v11i6.507.

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Yokota, Shumpei, Tomoyuki Imagawa, Takuji Murata, Minako Tomiita, Yasuhiko Itoh, Satoshi Fujikawa, Syuji Takei, and Masaaki Mori. "Guidance on the use of adalimumab for juvenile idiopathic arthritis in Japan." Modern Rheumatology 22, no. 4 (August 2012): 491–97. http://dx.doi.org/10.3109/s10165-011-0561-1.

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Anink, J., M. H. Otten, S. L. Gorter, F. H. M. Prince, M. A. J. van Rossum, J. M. van den Berg, P. A. van Pelt, et al. "Treatment choices of paediatric rheumatologists for juvenile idiopathic arthritis: etanercept or adalimumab?" Rheumatology 52, no. 9 (June 4, 2013): 1674–79. http://dx.doi.org/10.1093/rheumatology/ket170.

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Schmalbach, T., and G. Horneff. "FRI0324 Experience with adalimumab in 123 patients with juvenile idiopathic arthritis (JIA):." Annals of the Rheumatic Diseases 71, Suppl 3 (June 2013): 423.2–423. http://dx.doi.org/10.1136/annrheumdis-2012-eular.2781.

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Schmeling, H., and G. Horneff. "OP0063 Efficacy and Safety of Adalimumab in Children with Juvenile Idiopathic Arthritis." Annals of the Rheumatic Diseases 72, Suppl 3 (June 2013): A71.2—A71. http://dx.doi.org/10.1136/annrheumdis-2013-eular.268.

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Moretti, Davide, Ilaria Cianchi, Gaia Vannucci, Rolando Cimaz, and Gabriele Simonini. "Psoriatic Juvenile Idiopathic Arthritis Associated with Uveitis: A Case Report." Case Reports in Rheumatology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/595890.

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According to the definition proposed by the International League of Associations for Rheumatology (ILAR), juvenile idiopathic arthritis (JIA) is defined as an arthritis of unknown etiology, starting under 16 years of age and lasting for at least 6 weeks, once other known conditions have been excluded. JIA represents the most common chronic rheumatic disease of childhood and is considered an important cause of short- and long-term acquired disability in children. It is currently estimated that psoriatic JIA represents up to 10% of all JIA subtypes, and chronic uveitis may occur in 10 to 15% of children with psoriatic JIA. In this report we describe a case of psoriatic JIA complicated by uveitis, in a child failing previous treatments with nonsteroidal anti-inflammatory drugs, methotrexate, and etanercept. Finally, adalimumab was prescribed, which led to sustained clinical remission in both arthritis and uveitis.

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García-De-Vicuña, Carmen, Manuel Díaz-Llopis, David Salom, Rosa Bou, Jesus Díaz-Cascajosa, Miguel Cordero-Coma, Gabriela Ortega, et al. "Usefulness of Adalimumab in the Treatment of Refractory Uveitis Associated with Juvenile Idiopathic Arthritis." Mediators of Inflammation 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/560632.

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Purpose. To assess the efficacy and safety of adalimumab in patients with juvenile idiopathic arthritis (JIA) and associated refractory uveitis.Design. Multicenter, prospective case series.Methods. Thirty-nine patients (mean [SD] age of 11.5 [7.9] years) with JIA-associated uveitis who were either not responsive to standard immunosuppressive therapy or intolerant to it were enrolled. Patients aged 13–17 years were treated with 40 mg of adalimumab every other week for 6 months and those aged 4–12 years received 24 mg/m2body surface.Results. Inflammation of the anterior chamber (2.02 [1.16] versus 0.42 [0.62]) and of the posterior segment (2.38 [2.97] versus 0.35 [0.71] decreased significantly between baseline and the final visit (P<0.001). The mean (SD) macular thickness at baseline was 304.54 (125.03) μand at the end of follow-up was 230.87 (31.12) μ(P<0.014). Baseline immunosuppression load was 8.10 (3.99) as compared with 5.08 (3.76) at the final visit (P<0.001). The mean dose of corticosteroids also decreased from 0.25 (0.43) to 0 (0.02) mg (P<0.001). No significant side effects requiring discontinuation of therapy were observed.Conclusion. Adalimumab seems to be an effective and safe treatment for JIA-associated refractory uveitis and may reduce steroid requirement.

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Wei, S. S., and R. Sinniah. "Adalimumab (TNFαInhibitor) Therapy Exacerbates IgA Glomerulonephritis Acute Renal Injury and Induces Lupus Autoantibodies in a Psoriasis Patient." Case Reports in Nephrology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/812781.

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Adalimumab (Humira) is a tumour necrosis factorα(TNFα) inhibitor that is approved for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn's disease, ankylosing spondylitis, and juvenile idiopathic arthritis (Sullivan and Preda (2009), Klinkhoff (2004), and Medicare Australia). Use of TNFαinhibitors is associated with the induction of autoimmunity (systemic lupus erythematosus, vasculitis, and sarcoidosis or sarcoid-like granulomas) (Ramos-Casals et al. (2010)). We report a patient with extensive psoriasis presenting with renal failure and seropositive lupus markers without classical lupus nephritis after 18 months treatment with adalimumab. He has renal biopsy proven IgA nephritis instead. Renal biopsy is the key diagnostic tool in patients presenting with adalimumab induced nephritis and renal failure. He made a remarkable recovery after adalimumab cessation and steroid treatment. To our knowledge, this is a unique case of a psoriasis patient presenting with seropositive lupus markers without classical lupus nephritis renal failure and had renal biopsy proven IgA glomerulonephritis after receiving adalimumab.

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Alexeeva, E. I., E. V. Mitenko, S. I. Valieva, T. M. Bzarova, R. V. Denisova, K. B. Isaeva, T. V. Sleptsova, and A. M. Tchomakhidze. "EFFICACY AND SAFETY OF PEDIATRIC JUVENILE IDIOPATHIC ARTHRITIS AND UVEITIS TREATMENT WITH ADALIMUMAB." Current pediatrics 11, no. 1 (January 15, 2012): 111. http://dx.doi.org/10.15690/vsp.v11i1.141.

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Trachana, M., P. Pratsidou-Gertsi, G. Pardalos, N. Kozeis, M. Badouraki, and F. Kanakoudi-Tsakalidou. "Safety and efficacy of adalimumab treatment in Greek children with juvenile idiopathic arthritis." Scandinavian Journal of Rheumatology 40, no. 2 (November 25, 2010): 101–7. http://dx.doi.org/10.3109/03009742.2010.517546.

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Skrabl-Baumgartner, A., W. Erwa, W. Muntean, and J. Jahnel. "Anti-adalimumab antibodies in juvenile idiopathic arthritis: frequent association with loss of response." Scandinavian Journal of Rheumatology 44, no. 5 (May 14, 2015): 359–62. http://dx.doi.org/10.3109/03009742.2015.1022213.

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Brunelli, Juliana Barbosa, Clovis Almeida Silva, Sandra Gofinet Pasoto, Carla Gonçalves Schahin Saa, Katia Tomie Kozu, Claudia Goldenstein-Schainberg, Elaine Pires Leon, et al. "Anti-adalimumab antibodies kinetics: an early guide for juvenile idiopathic arthritis (JIA) switching." Clinical Rheumatology 39, no. 2 (November 9, 2019): 515–21. http://dx.doi.org/10.1007/s10067-019-04798-6.

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Lovell, Daniel J., Nicola Ruperto, Katerina Jarosova, Dana Nemcova, Veronika Vargova, Hartmut Michels, Elizabeth Chalom, et al. "A52: The Impact of Adalimumab on Growth in Patients With Juvenile Idiopathic Arthritis." Arthritis & Rheumatology 66 (March 2014): S77—S78. http://dx.doi.org/10.1002/art.38468.

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Матюнова, Алла, Alla Matyunova, Людмила Брегель, and Lyudmila Bregel. "MODERN JUVENILE IDIOPATHIC ARTHRITIS THERAPY OF WITH THE USE OF BIOLOGICAL MEDICATIONS IN A REGIONAL CHILDREN”S 3 LEVEL HOSPITAL - RESULTS AND PROBLEMS." Acta biomedica scientifica 2, no. 5 (January 18, 2018): 102–6. http://dx.doi.org/10.12737/article_5a3a0e4744a0a8.88140750.

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Background. Juvenile idiopathic arthritis is accompanied by severe functional disabilities refractory to standard treat- ment 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 re- ceiving 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.

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Goettel, Andrea M., Josh DeClercq, Leena Choi, Thomas B. Graham, and Amy A. Mitchell. "Efficacy and Safety of Abatacept, Adalimumab, and Etanercept in Pediatric Patients With Juvenile Idiopathic Arthritis." Journal of Pediatric Pharmacology and Therapeutics 26, no. 2 (February 15, 2021): 157–62. http://dx.doi.org/10.5863/1551-6776-26.2.157.

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OBJECTIVE The lack of randomized controlled trials comparing biologics for the treatment of juvenile idiopathic arthritis (JIA) has led to wide variation in treatment approaches. The objective of this study is to compare the efficacy and safety of abatacept, adalimumab, and etanercept in JIA patients treated at a tertiary pediatric institution. METHODS This was a single-center, retrospective chart review of patients initiated on abatacept, adalimumab, or etanercept from December 1, 2015, to August 31, 2018, at Monroe Carell Jr. Children's Hospital at Vanderbilt (VCH). The primary outcome was the change in the Physician Global Assessment (PGA) score after 4 to 6 months of biologic therapy. Secondary outcomes included change in laboratory markers of JIA disease activity, change in the number of joints with active disease or limitation of motion, reduction in corticosteroid dose, adverse effects, adherence among patients who have their medications filled at the institution's specialty pharmacy, and reason for discontinuation of therapy. RESULTS A total of 139 patients were included, with a median age of 13 years. Most patients, 80.6%, experienced a reduction in their PGA score after starting biologic therapy. There was not a statistically significant difference among the agents (p = 0.64). Adverse effects were reported in only 26.6% of patients, with the most frequent being injection site reactions or pain (n = 35). Ultimately, 32% of patients discontinued biologic therapy with a lack of efficacy being the most common reason. CONCLUSIONS Abatacept, adalimumab, and etanercept were not significantly different in efficacy and safety for the treatment of JIA at this single institution.

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Chen, C., K. L. Teh, T. Arkachaisri, L. Das, Y. X. Book, S. F. Hoh, and X. Gao. "POS1294 SAFETY AND EFFICACY OF ADALIMUMAB BIOSIMILAR (AMGEVITA) IN PAEDIATRIC RHEUMATOLOGY PATIENTS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 984.1–984. http://dx.doi.org/10.1136/annrheumdis-2022-eular.221.

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BackgroundThe approval of biosimilars requires pharmacokinetic studies to prove that there are no clinically significant differences to the originator molecule. These studies are also used to extrapolate additional indications and for different populations including paediatrics. Literature is lacking for the efficacy and safety of biosimilars for paediatric rheumatology conditions. Amgevita, a biosimilar of adalimumab, was approved for use in Singapore on 31 July 2019. It was used in KK Women’s and Children’s hospital (KKH), Singapore from 1 September 2020.ObjectivesTo report the safety and efficacy of adalimumab biosimilar in children at our centre.MethodsThis is an ongoing prospective, IRB-approved, observation study in a paediatric rheumatology clinic sited within KKH, a tertiary children’s hospital. Patients were reviewed in clinic to determine the need to initiate adalimumab (Amgevita), and completed pre-biologic screening to assess suitability to start. Patients were included if they received minimum 1 dose of adalimumab biosimilar. Safety parameters tracked: allergy, including urticaria, anaphylaxis, severe injection site reactions, rate of new onset infections requiring hospitalization and reactivation of latent infections (e.g., tuberculosis or herpes zoster). Adverse reactions were graded according to CTCAE v5.0. Efficacy parameters were tracked for patients with juvenile idiopathic arthritis (JIA) included JADAS27, JADAS71 and JSpADA.ResultsFrom 1 September 2020 to 31 October 2021, a total of 187 of 20mg syringes and 1403 pre-filled 40mg pens were dispensed to 117 paediatric rheumatology patients. Mean age was 14.9 years, 53.9% were male, 70.9% were Chinese and ethesitis-related arthritis (46.1%) was the most common indication. There were 68 (58.1%) biologic naïve patients. Two patients experienced injection-site urticaria which prompted discontinuation (grade 2). One patient reported initial injection site soreness which resolved spontaneously (grade 1). One patient developed latent tuberculosis requiring inpatient management and temporary interruption in adalimumab therapy (grade 3). No other adverse events were reported. Efficacy data was available for 96 patients. Median scores at baseline and at 3-months and 6-months are presented in Table 1.Table 1.Summary of paediatric patients initiated on adalimumab biosimilar (Amgevita)Diagnosis, n (%)Enthesitis related arthritisOf which HLA-B27 positive54 (46.1)44 (81.5)Polyarthritis21 (17.9)Extended or persistent oligoarthritis15 (12.8)Undifferentiated JIA6 (5.1)Psoriatic arthritis1 (0.8)Other indications21 (17.9)Concomitant DMARDs, n (%)Methotrexate50 (42.7)Sulfasalazine37 (31.6)*Efficacy, Median (range)Biologic naïveNot biologic naïveMonth number036036JADAS272(0-21.6)0(0-8.5)0(0-6.05)2(0-10.6)0(0-8.4)0(0-12.2)JADAS712(0-27.8)0(0-12.0)0(0-6.08)2(0-10.6)0(0-8.4)0(0-12.2)JSpADA0.25(0-3.5)0(0-1.0)0(0-1.0)0.5(0-1.5)0(0-0.5)0(0-2.0)DMARDs: Disease modifying anti-rheumatic drugs; JADAS: Juvenile Arthritis Disease Activity Score; JSpADA: Juvenile spondyloarthritis disease activity. *Efficacy data only for patients with juvenile idiopathic arthritisConclusionWe report our 14-month experience of using adalimumab biosimilar in a pediatric rheumatology population. Majority of the patients did not report major adverse reactions. Majority of JIA patients responded well when initiated on adalimumab (Amgevita). Rheumatologists should continually monitor patients for latent infections after prescribing biologics including biosimilars.References[1]Scientific considerations in demonstrating biosimilarity to a reference product: guidance for industry. FDA website. Apr 2015. https://www.fda.gov/media/82647/download. Accessed 28 Dec 2021.[2]De Cock D, Kearsley-Fleet L, Baildam E, Beresford MW, et al. Biosimilar Use in Children and Young People with Juvenile Idiopathic Arthritis in aReal-World Setting in the United Kingdom [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10).Disclosure of InterestsNone declared

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Chighizola, Cecilia Beatrice, Matteo Ferrito, Luca Marelli, Irene Pontikaki, Paolo Nucci, Elisabetta Miserocchi, and Roberto Caporali. "Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review." Biomedicines 10, no. 8 (August 21, 2022): 2041. http://dx.doi.org/10.3390/biomedicines10082041.

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Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.

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Tigrak, S. N., Ş. Çekiç, O. Yalcinbayir, and S. S. Kilic. "AB0751 JUVENILE UVEİTİS: THE 3RD LEVEL EXPERIENCE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1404.1–1404. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3933.

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Background:Uveitis is the inflammation of the uveal components of the eye (iris, choroid and retina) and is the third leading cause of blindness in the world. It is less common in children than adults. Young children are usually diagnosed late, as they cannot express their complaints.Objectives:With this work; We aimed to contribute to the literature by determining the underlying primary diagnosis and evaluating the treatment response in patients who were followed up in our clinic with a diagnosis of non-infectious uveitis, mostly juvenile idiopathic arthritis.Methods:93 patients under 18 years of age who were followed up with a diagnosis of non-infectious uveitis were included in the study. The data of the patients were scanned retrospectively. According to the last biomicroscopic examinations, the patients were classified as remission, inactive period and active disease. Clinical characteristics, laboratory findings, family history, drugs used during the disease and duration of treatment were examined.Results:The male to female ratio was 1,06 (48/45). The mean age at diagnosis of childhood uveitis was found to be 10±4.02. 49 Patients (52.6%) were diagnosed with idiopathic uveitis, 33 (33.5%)with juvenile idiopathic arthritis, 11 (11.7%) with Behçet’s, 2 (2.2%) with FMF. Juvenile idiopathic arthritis was the most common systemic disease in the patient group. The mean age of patients with uveitis to be diagnosed with rheumatological disease was 10.1±5.32. ANA test was positive in 30 (32.2%) patients. 23 (69.7%) of juvenile idiopathic arthritis patients were oligoartricular type. Anterior uveitis was present in 37 (39.8%) of the patients. Anterior uveitis was most common in the juvenile idiopathic arthritis cases. Of the patients with uveitis, 24 (25.8%) were intermediate, 11 (11.8%) were posterior, 21 (22.6%) were panuveitis. Anti-TNFα agents were administered to patients with unresponsiveness to immunosuppressive therapy and high risk of vision loss. Most used anti-TNFα agents were infliximab and adalimumab. Glaucoma, cataract, and posterior synechiae were common complications in the patients during follow-up.Conclusion:The most common systemic disease that cause noninfectious uveitis in children is juvenile idiopathic arthritis. In juvenile idiopathic arthritis, the most common involvement of the eye was the anterior segment, and it was thought that the location of the eye involvement could be useful in determining the underlying systemic disease. It is important to ensure regular eye examination in patients with rheumatologic symptoms.Disclosure of Interests:None declared

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Kärki, J., T. Levälampi, P. Vähäsalo, M. Backström, L. Kröger, M. Malin, A. Putto-Laurila, et al. "SAT0488 ETANERCEPT CONCENTRATION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1200–1201. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1232.

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Background:Etanercept (ETN) is the most used TNF blocker in children with JIA. There is still limited real-life data of etanercept concentrations in children, especially in association with dosing.Objectives:The aim of the study was to investigate association between ETN dosing and serum trough concentration in children with non-systemic JIA.Methods:We conducted a multicenter retrospective study of 180 Finnish JIA patients (Table 1) receiving ETN either as monotherapy or in combination with one or more DMARDs (Table 2). Prior biologicals were used by 17 % of the patients. Patients were divided into two groups, ETN started before or after one year of diagnosis (Figure 1). ETN concentration samples (collected 2014-2017) were analyzed using validated enzyme-linked immunosorbent assay (ELISA) in Sanquin Diagnostics, Amsterdam, the Netherlands.Results:Demographics at etanercept start and diagnoses are shown in Table 1. Duration of the treatment with ETN, ETN doses, concentrations and concomitant medications at the time of concentration measurement are shown in Table 2.Association between ETN dose and concentration is shown in Figure 1.Those who started medication early (< 1 year from diagnosis) were younger than those who started later (Table 1) and association between ETN dose and concentration was more obvious (Figure 1).Conclusion:There was an association between etanercept dose used and serum trough concentration and it was more evident when medication was started early after diagnosis, when the patients were younger and BSA lower.References:[1]Kneepkens EL et al. Lower etanercept levels are associated with high disease activity in ankylosing spondylitis patients at 24 weeks of follow-up. Ann Rheum Dis 2015;74(10):1825-9.[2]Bader-Meunier B et al. Etanercept concentration and immunogenicity do not influence the response to Etanercept in patients with juvenile idiopathic arthritis. Semin Arthritis Rheum 2019;48(6):1014-1018.Disclosure of Interests:None declared

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Gaidar, E. V., M. M. Kostik, M. F. Dubko, V. V. Masalova, L. S. Snegireva, E. A. Isupova, T. N. Nikitina, E. D. Serogodskaya, O. V. Kalashnikova, and V. G. Chasnyk. "The Efficiency of Adalimumab in Cases of Chronic Methotrexate-Resistant Juvenile Idiopathic Arthritis-Associated Anterior Uveitis: Retrospective Case Series Study." Pediatric pharmacology 13, no. 4 (November 15, 2016): 340–44. http://dx.doi.org/10.15690/pf.v13i4.1605.

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Background: Juvenile idiopathic arthritis (JIA) associated uveitis may be the cause of not only visual acuity decrement, but also blindness. At the same time, in some patients therapy with methotrexate can not prevent the development of these complications.Objective: Our aim was to investigate the efficiency and safety of using a tumor necrosis factor inhibitor (adalimumab) in patients with JIA-associated uveitis.Methods: We conducted a retrospective single-arm study of a series of cases. The results of using adalimumab were evaluated in patients with JIA-associated chronic anterior uveitis, who have been under observation for no less than 1 year before and after starting using adalimumab. The latter was prescribed due to progressing and/or recidivous methotrexate-resistant uveitis.Results: We have analyzed clinical case records of 36 children with JIA-associated uveitis. At the start of therapy with adalimumab, actual uveitis was diagnosed in 30 (83%) patients. Remission was achieved in 29 of 30 cases in 2 (2; 12) weeks in patients with actual uveitis. 11 (31%) patients had a uveitis exacerbation 28 (13; 69) weeks after adalimumab therapy started. Adalimumab reduced the exacerbation frequency from 4 (1; 9) to 0 (0; 1) exacerbations per year for one patient (p < 0,001), and reduced the proportion of patients who were treated with topical glucocorticosteroids (from 83 to 8%). There were no differences (in achieving remission and reducing exacerbation frequency) with regard to patients’ sex, involvement of one or both eyes in the disease onset, antinuclear factor seropositiveness, uveitis type and character of joints affection.Conclusion: Adalimumab promotes fast and long-lasting remission of JIA-associated methotrexate-resistant uveitis.

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Lazarević, Dragana, Marija Ratković Janković, Milica Jakovljević, and Jelena Vojinović. "LONG TERM EFFICACY AND SAFETY OF ADALIMUMAB IN JUVENILE IDIOPATHIC ARTHRITIS (JIA) ASSOCIATED UVEITIS." Acta Medica Medianae 60, no. 3 (September 15, 2021): 30–36. http://dx.doi.org/10.5633/amm.2021.0304.

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Skrabl-Baumgartner, Andrea, Gerald Seidel, Beate Langner-Wegscheider, Axel Schlagenhauf, and Jörg Jahnel. "Drug monitoring in long-term treatment with adalimumab for juvenile idiopathic arthritis-associated uveitis." Archives of Disease in Childhood 104, no. 3 (July 19, 2018): 246–50. http://dx.doi.org/10.1136/archdischild-2018-315060.

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ObjectivesAssessing influence of anti-adalimumab (ADA) antibodies (AAA) on serum trough ADA levels and uveitis activity in long-term ADA treatment of juvenile idiopathic arthritis (JIA)-associated uveitis.Patients and interventionsThis prospective observational study included 20 patients from a single centre treated with ADA for active uveitis refractory to conventional disease-modifying antirheumatic drugs. AAA, serum ADA trough levels and uveitis activity were evaluated at regular intervals up to 6 years.ResultsAAA were detected in nine patients (45%). Permanent AAA in seven were associated with undetectable ADA trough levels and loss of response (LOR). Transient AAA were detected in four with measurable ADA trough levels and response of uveitis to treatment, followed in two by permanent AAA associated with LOR. Use of concomitant immunosuppression was significantly higher in patients without AAA (p<0.05).ConclusionsAAA-associated LOR frequently occurs in long-term treatment with ADA for JIA-associated uveitis. Concomitant immunosuppressive therapy significantly reduces the risk of LOR due to AAA.

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Alekseeva, E., E. Mitenko, T. M. Bzarova, S. I. Valiyeva, K. B. Isayeva, A. M. Chomakhidze, R. V. Denisova, and T. V. Sleptsova. "SAT0128 Efficacy and safety of adalimumab treatment for refractory juvenile idiopathic arthritis-associated uveitis." Annals of the Rheumatic Diseases 71, Suppl 3 (June 2013): 514.1–514. http://dx.doi.org/10.1136/annrheumdis-2012-eular.3075.

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Mozaffarian, N., M. Karunaratne, and V. Arora. "SAT0444 Administration of Routine Preventative Vaccinations in Children with Juvenile Idiopathic Arthritis Receiving Adalimumab." Annals of the Rheumatic Diseases 72, Suppl 3 (June 2013): A732.1—A732. http://dx.doi.org/10.1136/annrheumdis-2013-eular.2168.

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Breitbach, Marc, Christoph Tappeiner, Michael R. R. Böhm, Beatrix Zurek-Imhoff, Carsten Heinz, Solon Thanos, Gerd Ganser, and Arnd Heiligenhaus. "Discontinuation of long-term adalimumab treatment in patients with juvenile idiopathic arthritis-associated uveitis." Graefe's Archive for Clinical and Experimental Ophthalmology 255, no. 1 (September 30, 2016): 171–77. http://dx.doi.org/10.1007/s00417-016-3497-5.

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Bogmat, Ludmila, Anastasia Fadeeva, Nataliya Shevchenko, and Viktoria Nikonova. "The state of physical functionning of patients with juvenile idiopathic arthritis in the assessment of quality of life." 8, no. 8 (December 29, 2021): 11–21. http://dx.doi.org/10.26565/2617-409x-2021-8-01.

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Summary. Juvenile idiopathic arthritis is a severe chronic childhood disease that affects not only the joints but is also accompanied by various comorbid conditions, among which eye damage (uveitis) is the most common. In addition to a significant impact on the general condition of the child, this disease also affects the main indicators of quality of life: physical activity, emotional activity, activity in educational institutions, and the social sphere. During the period of active study of Juvenile idiopathic arthritis patients quality of life, a decrease in its overall level is noted due to almost all components, but physical activity shows the lowest values in some studies, which is associated with joint damage, activity, and duration of the disease. Objective. To determine the state of physical functioning and assess the overall level of quality of life in patients with JIA, considering the subtype of the disease duration and the therapy complex. Materials and Methods. The study was carried out at SI "Institute for Children and Adolescents Health Care of the NAMS of Ukraine", Kharkiv, from November 2020 till November 2021. There 118 patients with juvenile idiopathic arthritis were examined, including 47 with polyarticular, 43 with oligoarticular, 28 with uveitis-associated subtypes. The investigation involved 77 girls and 41 boys in age from 2 till 18 years old. The therapy by methotrexate was provided in 111 patients, among them 30 had methotrexate with immunobiological therapy (29 adalimumab, 1 – tocilizumab), 6 – sulfasalazine. The disease duration due to disease subtype was in children with polyarthritis – (49,2±6,7), oligoarthritis – (35,4±4,2), uveitis-associated subtypes of juvenile idiopathic arthritis – (76,8±10,2) months. Disease activity was assessed using the Juvenile Arthritis Disease Activity Score 27-joint reduced count questionnaire, functional state according to he Child Health Assessment Questionnaire and quality of life according to PedsQLTM 4.0 Generic Core Scales. Results. It was found that high juvenile idiopathic arthritis activity was observed in 31 (26.2%) patients, equally often in all subgroups of children. Index functional state did not show a significant decrease either in the whole group or in each of the arthritis subgroups. The overall indicator of quality of life in children with juvenile idiopathic arthritis was reduced in the whole group (71.2±1.4 and 72.9±1.4 per week and month). There was no significant difference between the quality of life indicators of boys and girls. at the same time, physical activity indicators were the lowest in the group with polyarticular juvenile idiopathic arthritis, regardless of gender and age of children, and especially low in children with polyarthritis in the first year of the disease. They also turned out to be worse in children with uveitis-associated subtypes of juvenile idiopathic arthritis with the disease from one to three years. The highest level of the physical component of quality of life was observed in children with oligoarthritis older than 14 years and in children under 8 years of age in the uveitis-associated subtypes of juvenile idiopathic arthritis group. There was no significant effect on the physical indicators of quality of life of the start treatment timing. (р≤0,05). Conclusions. A decrease in quality of life and its physical component is typical for children with different types of juvenile idiopathic arthriti (oligoarticular, polyarticular, and uveitis-associated subtypes of juvenile idiopathic arthritis). It has been established that children with polyarticular subtype of arthritis have the greatest decrease in quality of life and physical functioning.

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Galstian, Lelia A., Maksim V. Verbitsky, Angelina V. Polyanskaya, Svetlana N. Chebysheva, Mariya A. Kudryashova, Oksana V. Batyreva, Margarita I. Tikhaya, and Elena S. Zholobova. "Experience of switching biological therapy in a patient with juvenile idiopathic arthritis and uveitis. Case report." Pediatrics. Consilium Medicum, no. 2 (July 30, 2022): 192–96. http://dx.doi.org/10.26442/26586630.2022.2.201544.

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Uveitis associated with juvenile arthritis can be complicated by cataracts, retinal edema, and glaucoma, which carries a potential risk of disability in the child's organ of vision. Approximately 2540% of patients demonstrate insufficient effectiveness of the ongoing standard antirheumatic therapy, which requires the inclusion of genetically engineered biological therapy. According to the protocols, the drug of choice for juvenile arthritis associated with uveitis is adalimumab, which has shown high efficacy in many studies. However, some patients stop responding to therapy over time, which raises the question of switching to another genetically engineered biological drug (GЕBD). Our article presents a case of severe course with an early onset of juvenile idiopathic arthritis associated with uveitis. Due to the insufficient effectiveness of basic monotherapy with methorexate, as well as topical glucocorticoids, adilimumab was added to therapy a year after the onset of the disease. Over the next 5 years, the child was on this therapy with exacerbations of uveitis about 12 episodes per year. Subsequently, uveitis began to continuously recur, which raised the question of the development of probable resistance to adalimumab and the change of GEBD. The girl was switched to golimumab, which is a human monoclonal antibody that can bind to tumor necrosis factor-. This drug has been used for the treatment of juvenile idiopathic arthritis since 2017 for children weighing 40 kg and above, and after the completion of the multicenter GO-KIDS study, it is registered for children from 2 years of age. According to a number of studies, golimumab has shown its effectiveness in relation to the activity of uveitis in patients with arthritis, including those in childhood. In general, the issues of switching GEBD in cases of ineffective therapy with first-line drugs are a very urgent problem in pediatric rheumatology. In our case, switching to the GIBP golimumab resulted in a positive effect on the activity of rheumatoid uveitis and induction of remission of the articular syndrome.

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Quartier, Pierre, Amandine Baptiste, Véronique Despert, Emma Allain-Launay, Isabelle Koné-Paut, Alexandre Belot, Laurent Kodjikian, et al. "ADJUVITE: a double-blind, randomised, placebo-controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis." Annals of the Rheumatic Diseases 77, no. 7 (December 23, 2017): 1003–11. http://dx.doi.org/10.1136/annrheumdis-2017-212089.

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ObjectivesTo assess the efficacy and safety of adalimumab on uveitis in patients with early onset, chronic, juvenile idiopathic arthritis (JIA)-associated or idiopathic anterior uveitis and an inadequate response to topical steroids and methotrexate (MTX).MethodsPatients aged 4 years or more with ocular inflammation quantified by laser flare photometry (LFP) ≥30 photon units/ms were double-blindly randomised (1:1) to 2 groups, one treated with placebo and one with adalimumab subcutaneously at a dose of 24 mg/m2 in patients aged <13 years, 40 mg in the others, every other week. The primary outcome was response at month 2 (M2) defined as a 30% reduction of inflammation on LFP in the assessable eye with more severe baseline inflammation and no worsening on slit lamp examination. From M2 to M12, all patients received adalimumab.ResultsAt M2, among 31 patients included in intention-to-treat analysis, there were 9/16 responders on adalimumab and 3/15 on placebo (P=0.038, Χ2 test; relative risk=2.81, 95% CI 0.94 to 8.45; risk difference: 36.3%, 95% CI 2.1 to 60.6); there was no significant difference using the Standardised Uveitis Nomenclature classification criteria of improvement. Thirty patients continued the trial after M2 and received adalimumab (open-label phase), 29 reached M12. There were seven serious adverse events none related to study treatment.ConclusionsThis trial is in favour of using adalimumab in patients with early onset, chronic anterior uveitis, which is in most cases associated with JIA, in case of inadequate response to topical therapy and MTX. LFP could be a valuable tool to assess early treatment efficacy.Trial registration numberNCT01385826.

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Sevostyanov, V. K., P. S. Lototskaya, N. V. Babich, D. D. Rassoha, A. S. Novikov, S. L. Balashov, and E. S. Zholobova. "ANALYSIS OF THE SURVIVAL OF GENETICALLY ENGINEERED BIOLOGICAL THERAPY IN JUVENILE IDIOPATHIC ARTHRITIS." Pediatria. Journal named after G.N. Speransky 101, no. 4 (August 19, 2022): 55–63. http://dx.doi.org/10.24110/0031-403x-2022-101-4-55-63.

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The problem of the survival of various genetically engineered biological drugs (GEBD) is of a current scientific interest. A clear analysis of the reasons for the withdrawal coupled with the GEBD switching algorithmizing would allow developing of the individual treatment plans and monitoring of the patients. The objective of the study was to analyze the survival of genetically engineered biological therapy in children with juvenile idiopathic arthritis (JIA) through identifying the frequency and structure of cases of switching/cancellation of GEBD. Materials and methods: based on the data obtained from the Moscow registry of children with rheumatic diseases, an observational analytical cross-sectional study was conducted, including patients with JIA aged 0 to 17 years old living in Moscow, who had a history of episodes of switching or cancellation of GEBD. The study was conducted from January, 2015 to December, 2021. Results: 1220 patients (35.8% male/64.2% female) with JIA were included in the study. The median age of patients was 11.0 (8.0; 15.0) years. The total number of prescribing of GEBD of the first and subsequent lines was 589 episodes in 531 patients, of which 46 patients had 64 episodes of switching or cancellation of GEBD, which accounted for 10.9% of all cases of prescribing of GEBD. In the structure of the reasons for the therapy change the secondary failure accounted for 57.8%, the primary failure - 12.5%, intolerance - 10.9%, de novo uveitis - 9.4%. Cancellation of the drug therapy due to the achievement of remission was noted in 6.2% of cases. There are statistically significant differences in the duration of therapy depending on the reason for discontinuation or replacement of therapy (p<0.001). More often, patients were transferred to adalimumab (29.3%), and when adalimumab was canceled, to tocilizumab and golimumab. In the event of tocilizumab discontinuation, the majority of patients were switched to canakinumab drug therapy. Conclusion: the presented analysis is one of a few studies of such kind that were ever conducted in Russia; it requires further accumulation and analysis of data, including cases of discontinuation of the drug therapy, switching between the drugs, as well as the duration of therapy before the event that caused the change or discontinuation of the drug therapy happened.

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Horneff, Gerd, Marieke M. B. Seyger, Dilek Arikan, Jasmina Kalabic, Jaclyn K. Anderson, Andreas Lazar, David A. Williams, Chen Wang, Rita Tarzynski-Potempa, and Jeffrey S. Hyams. "Safety of Adalimumab in Pediatric Patients with Polyarticular Juvenile Idiopathic Arthritis, Enthesitis-Related Arthritis, Psoriasis, and Crohn's Disease." Journal of Pediatrics 201 (October 2018): 166–75. http://dx.doi.org/10.1016/j.jpeds.2018.05.042.

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Buckley, Lisa, Eileen Ware, Genna Kreher, Lisa Wiater, Jay Mehta, and Jon M. Burnham. "Outcome Monitoring and Clinical Decision Support in Polyarticular Juvenile Idiopathic Arthritis." Journal of Rheumatology 47, no. 2 (July 15, 2019): 273–81. http://dx.doi.org/10.3899/jrheum.190268.

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Objective.Inconsistent assessment and treatment may impair juvenile idiopathic arthritis (JIA) outcomes. We aimed to improve polyarticular JIA (rheumatoid factor–positive and –negative) outcomes by standardizing point-of-care disease activity monitoring and implementing clinical decision support (CDS) to reduce treatment variation.Methods.We performed a quality improvement initiative in an outpatient pediatric rheumatology practice. The interventions, implemented from April to November 2016, included standardized disease activity measurement, disease activity target review, and phased introduction of polyarticular JIA CDS to guide medication selection, dosing, treatment duration, and tapering. Process measures included visit-level target attestation (goal: 50%) and CDS use (goal: 15%). Our goal was to reduce the polyarticular JIA clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) by at least 10%. Included patients had at least 2 visits from April 2016 through July 2017, and were classified as having early (≤ 6 mos) or established disease (> 6 mos).Results.Patients with polyarticular JIA (n = 97; 81% established disease) were observed for 10.3 months (interquartile range: 6.4–12.3). Target attestation and CDS use occurred in a mean of 77% and 45% of polyarticular JIA visits, respectively. The median cJADAS-10 decreased significantly in both early (16.5 to 2.7, p < 0.001) and established polyarticular JIA (2.1 to 1.0, p = 0.01). A high proportion of patients with early disease received biologic therapy (73.7%). In established disease, although prescription of nonbiologic and biologic disease-modifying antirheumatic drugs remained similar overall, adalimumab prescribing increased (12.8% to 23.1%, p = 0.008).Conclusion.Implementation of structured disease activity monitoring and CDS in polyarticular JIA was associated with significant reductions in disease activity scores in both early and established disease.

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Consolaro, Alessandro, Stefano Lanni, Alberto Martini, and Angelo Ravelli. "Adalimumab-Induced Clinical Remission in Refractory and Long-Standing Systemic Juvenile Idiopathic Arthritis: Case Report." Annals of Paediatric Rheumatology 3, no. 1 (2014): 29. http://dx.doi.org/10.5455/apr.031720142111.

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