Vol 9, No 2 (2023)
Guidelines / Expert consensus
Published online: 2023-06-13

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Secukinumab in the treatment of patients with juvenile idiopathic arthritis categories of enthesitis-related arthritis and juvenile psoriatic arthritis — an experts’ opinion of the Polish Society of Rheumatology and the Section of Developmental Age Rheumatology of the Polish Society for Rheumatology

Zbigniew Michał Żuber1, Elżbieta Smolewska2, Violetta Opoka-Winiarska3, Marcin Stajszczyk4, Bogdan Batko5
Rheumatology Forum 2023;9(2):42-48.

Abstract

According to the juvenile idiopathic arthritis (JIA) classification criteria there are two categories of the disease within the spondyloarthropathies spectrum — enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA). These are chronic rheumatic paediatric diseases, that manifest themselves with heterogeneous clinical symptoms and comorbidities, resulting in pain, growth and development impairment, deteriorated physical fitness and lowered health-related quality of life. Juvenile spondyloarthropathies may occur in 25 percent of patients with JIA. The age of onset usually is above 10, but it happens that correct diagnosis is delayed by a few years. Problems with a diagnosis of axial spondyloarthropathy in children may arise from the fact, that inflammation of the sacroiliac joints may be clinically silent at the beginning of the disease, which results in lesser sensitivity of the Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthropathies in paediatric practice. Concurrently it is key to rapidly introduce effective treatment, that should enable proper development and further life without active inflammation and its long-term complications. Guidelines for the pharmacotherapy of children with JIA include the use of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids (GCSs), classic disease-modifying anti-rheumatic drugs (cDMARDs) and biological treatment. Amongst biologics, drugs that for a long time are used in various categories of JIA are medications out of the TNF alpha inhibitors group. Unfortunately, there is a large group of patients for whom such therapy is inadequate or unavailable (no biological therapy is currently reimbursed in the ERA and JPsA categories). This leads to prolonged corticosteroid therapy, the complications of which are drastic for a growing child. Out of therapies with a different mechanism of action, in the population of patients with ERA and JPsA inhibiting interleukin 17 (IL-17) proved to be effective. One medication out of this group — secukinumab (SEC) — in June 2022 was granted market authorization for use in these disease categories based on the findings of the JUNIPERA clinical registration trial. This study demonstrated that SEC (added to the option to use conventional disease-modifying anti-rheumatic drugs — SEC ± cDMARDs) allows a statistically significant reduction of the disease flare risk by 72% in comparison to the PLC ± cDMARDs group. What is more, better results have been attained in the SEC group with regard to such clinical symptoms as: JIA ACR 30, 50, 70, 90, and 100 responses, inactive disease status, enthesitis count, or the active joint count. During the JUNIPERA trial no deaths have been recorded. Differences in the adverse events rates between the SEC and placebo groups were small and clinically insignificant. The rate of serious adverse events was low both in the SEC treatment group as well as placebo. The above results show that patients with ERA and JPsA have gained a new effective and safe therapeutic option, that addresses an unmet medical need in that group of patients. Adequately rapid implementation of IL-17 inhibitors may prevent mobile disability and extraarticular damage in patients with ERA and JPsA.

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