Etanercept is recommended for children aged 4 to 17 years who have active JIA in at least five joints and whose condition has not responded adequately to methotrexate or who have been unable to tolerate treatment with methotrexate.
Etanercept should be prescribed in accordance with relevant sections of the protocol that has been produced by the British Paediatric Rheumatology Group (BPRG). The BPRG protocol sets out the criteria for who should or should not be eligible for treatment and defines ‘failure’ of standard therapy. It also sets out the criteria for withdrawal of etanercept treatment, which include withdrawal of treatment if severe side effects occur, or if there is no response to treatment after 6 months.
Only a consultant who regularly sees children and young people with JIA and who runs specialised paediatric rheumatology clinics should prescribe etanercept. In addition, the clinic should have a nurse specialist or an appropriately trained nurse who is able to teach children and parents how to inject etanercept, and who does this regularly. Follow-up treatment will depend on local circumstances, and may be provided on a ‘shared-care’ basis, where GPs monitor patients’ progress and any side effects.
The doctor who prescribes etanercept or infliximab should, with the parents’ and/or child’s consent, register the child with the Biologics Registry, which has been set up by the BPRG. Every3 months, the doctor will send information to the Registry on the dosage, the effects of the treatment and any side effects. This information will help researchers to find out about the long-term effectiveness and side effects of treatment with etanercept.
At the moment there is no evidence from clinical studies to show how effective etanercept for the treatment of JIA is beyond 2 years. Therefore the doctor should make a decision about whether to continue treatment with etanercept on the basis of how the child’s condition is progressing and how well the drugs are working.