Dynamics of serum levels of TNF-α in a longitudinal follow-up study in 98 patients with juvenile idiopathic arthritis treated with anti-TNF-α biological drugs

• Published in: Clinical rheumatology Vol. 43; no. 7; pp. 2287 - 2293
• Main Authors: Morozova, N., Avramovič, M. Zajc, Markelj, G., Toplak, N., Avčin, T.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2024; Springer Nature B.V
• Subjects: Adalimumab - therapeutic use; Adolescent; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Juvenile - blood; Arthritis, Juvenile - drug therapy; Biological activity; Biological products; Biomarkers; Biomarkers - blood; Child; Child, Preschool; Correlation analysis; Drugs; Etanercept; Etanercept - therapeutic use; Female; Follow-Up Studies; Humans; Immunology; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Monoclonal antibodies; Original; Original Article; Patients; Remission; Remission (Medicine); Rheumatology; Serum levels; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - blood; Tumor necrosis factor-α; Cytokines; Etanercept; Adalimumab; Tumour necrosis factor-alpha; Juvenile idiopathic arthritis
• ISSN: 0770-3198; 1434-9949; 1434-9949
• DOI: 10.1007/s10067-024-07012-4

Objective
To determine the dynamics of serum levels of TNF-α in patients with juvenile idiopathic arthritis (JIA) treated with anti-TNF-α biological drugs and investigate their association with the disease activity.
Methods
We conducted a single-centre, observational cohort study in 98 patients with JIA (30 boys, 68 girls, mean age 11.3 years) treated with anti-TNF-α biological drugs. Clinical examinations and laboratory assessments of serum levels of TNF-α were performed before starting therapy with biological drug and at 6-month intervals afterwards up to 2.5 years.
Results
The analysis of serum levels of TNF-α in relation to the disease activity states showed the highest mean serum levels of TNF-α in patients on etanercept who had low disease activity states and in patients on adalimumab who had inactive disease. The correlation analysis in patients with JIA treated with etanercept or adalimumab showed a weak negative correlation between the serum levels of TNF-α and JADAS10 scores (
p
 = 0.007), (
r
 =  − 0.177).
Conclusion
The assessment of serum levels of TNF-α in children with JIA during treatment with etanercept or adalimumab is not a reliable biomarker of disease activity or immunological remission. Longitudinal measurement of TNF-α has no added clinical value in patients with JIA treated with anti-TNF-α biological drugs.
Key Points
• There is limited evidence regarding the effect of anti-TNF therapy on serum concentrations of TNF-α in patients with juvenile idiopathic arthritis
• Our study showed an increase in the serum level of TNF-α after the initiation of therapy with either etanercept or adalimumab, which was more significant in patients with inactive or low disease activity
• Serum TNF-α is most likely not biologically active during therapy with TNF-α inhibitors and therefore not a reliable biomarker of disease activity or immunological remission in patients with juvenile idiopathic arthritis