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Low Etanercept Concentrations in Children With Obesity and Juvenile Idiopathic Arthritis

Stephen J Balevic, Mara L Becker, Daniel Gonzalez

    The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
    |November 18, 2021
    PubMed

    Insights

    Children with juvenile idiopathic arthritis (JIA) who are obese may receive lower etanercept (ETN) drug exposure due to current dosing strategies. This study found higher body weight and BMI percentile are linked to reduced ETN serum concentration, suggesting potential under-dosing.

    Area of Science:

    • Pediatric Rheumatology
    • Pharmacokinetics
    • Obesity Medicine

    Background:

    • Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease affecting children.
    • Etanercept (ETN) is a biologic therapy used for JIA, but its efficacy can be influenced by patient factors.
    • Obesity is a growing concern in pediatric populations and may impact drug disposition.

    Purpose of the Study:

    • To investigate the relationship between body size and etanercept (ETN) drug exposure in pediatric patients with JIA.
    • To determine if obesity affects ETN plasma concentrations in children with JIA.
    • To inform potential adjustments in dosing strategies for obese pediatric patients.

    Main Methods:

    • A pilot, cross-sectional, observational study was conducted in a real-world cohort of children with JIA receiving ETN.
    • Analyzed the association between body size (weight, BMI percentile) and ETN plasma concentrations, adjusting for dosage.
    • Categorized body size using CDC guidelines to assess dose-normalized concentrations across different weight classes.

    Main Results:

    • A cohort of 29 children with JIA receiving weekly subcutaneous ETN was analyzed.
    • Dose-normalized ETN concentrations significantly decreased with increasing weight (p=0.004) and BMI percentile (p=0.04).
    • Obese children (87.5%) receiving maximum ETN dosage had weight-based doses below 0.8 mg/kg/dose.

    Conclusions:

    • Higher body weight and BMI percentile are significantly associated with lower serum ETN concentrations in children with JIA, independent of dose.
    • Current ETN dosing strategies may lead to under-dosing in obese pediatric patients.
    • Optimizing ETN dosing for children of all sizes is crucial for achieving therapeutic success and preventing long-term morbidity.
    Abstract

    Keywords:
    etanerceptjuvenile idiopathic arthritisobesityprecision dosing

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