郭和昌醫師(Ho-Chang Kuo, MD.)於2008 May-夏威夷第4屆亞洲兒科醫學研究會議(ASPR)報告內容

Ho-Chang Kuo, MD; Hong-Ren Yu, MD; Lin Wang, MD; Chih-Chung Wu, MD and Kuender D. Yang, MD, PhD.


Objective: Etanercept is an effective biologic agent for inhibition of tumor necrosis factor, and has a beneficial effect on treatment of children with juvenile rheumatoid arthritis (JRA), especially for those who are refractory to traditional therapy of methotrexant (MTX) with or without prednisolone.

Patients and methods: We reported our experience of 5 consecutive patients in Chang Gung Memorial Hospital-Kaohsiung Medical Center , Taiwan . Four patients with polyarticular type and the other one with systemic type were treated with etanercept (0.4 mg/kg, with maxima 25mg, subcutaneously, twice a week) for at least 3 months. Patients who had persistent fever, arthritis/arthragia or high inflammatory mediators (C-reactive protein, CRP and/or erythrocyte sedimentation rate, ESR) after treatment with MTX (over 10 mg/m2/week) and/or prednisolone (0.25mg/day/kg) for more than 3 months were enrolled in this study.

Results: The inflammatory markers (CRP and ESR) showed markedly decrease after etanercept in all patients with polyarticular type. The other one patient with systemic type had persistent fever and clinical symptoms after administration of etanercept for 6 weeks. Levels of hemoglobin increased whereas platelet counts decreased after etanercept treatments in the 4 polyarticular type patients. We reported our experience on etanercept treatment of JRA with following characteristics: 1) poor treatment response in systemic type; 2) well tolerance and treatment response in polyarticular type; 3) Hemoglobin levels increase and platelet counts decreased to within normal range after etanercept treatment; 4) no obvious side effects; and 5) successful taper of MTX and prednisolone, and even single therapy agent with etanercept in JRA.

Conclusions: Entanercept is beneficial for patients with polyarticular type JRA who refractory to traditional treatment, but not beneficial for systemic type in this study.

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