Pediatrics Medical News about primary systemic vasculitis of the young;biologic therapy

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Biologic therapy in primary systemic vasculitis of the young
Rheumatology, 06/22/09

Eleftheriou D et al. – Data provide evidence of efficacy of biologic agents in children with primary systemic vasculitis (PSV), and highlight the associated infectious complications. Further multicentre standardization of treatment protocols and data collection is required.

Methods

Aim was to describe the biologic treatment regimens and report the efficacy and safety of biologic therapies in children with PSV
A case series of children with PSV treated with biologic therapy between Feb 2002 and Nov 2007
Primary outcome assessment measures:
- Daily corticosteroid dose
- Birmingham Vasculitis Activity Score (BVAS), and
- Adverse events (including infection rate)

Results

25 pts; median age 8.8 yrs; 11 male with active PSV:
- 6 with anti-neutrophil cytoplasmic antibody associated vasculitides
- 11 with polyarteritis nodosa
- 7 with unclassified vasculitis and
- 1 with Behçet's disease
  were treated with biologic agents including infliximab, rituximab, etanercept, adalimumab or multiple biologics sequentially
A reduction in BVAS from a median of 8.5 at start of therapy to 4 at 32 mo f/u
This was accompanied by reduction in median daily prednisolone requirement from 1 to 0.25 mg/kg/d
For those receiving multiple biologic agents sequentially, a similar clinical improvement was observed with corticosteroid sparing
Infections occurred in 24%, the most severe in those receiving infliximab