Biological disease-modifying antirheumatic drugs for enthesitis-related arthritis
The approach to managing enthesitis-related arthritis, and the role of biological disease-modifying antirheumatic drugs (bDMARDs) in inducing and maintaining remission, is described in Management of enthesitis-related arthritis.
When a conventional synthetic disease-modifying antirheumatic drug (csDMARD) has not adequately controlled the symptoms of enthesitis-related arthritis, a biological disease-modifying antirheumatic drug (bDMARD) may be used. Tumour necrosis factor (TNF) inhibitors (adalimumab, etanercept, infliximab) are bDMARDs effective for enthesitis-related arthritis. Choice of TNF inhibitor is determined by availability and patient preference. At the time of writing adalimumab and etanercept are the only bDMARDs available on the Pharmaceutical Benefit Scheme (PBS) for enthesitis-related arthritis. PBS limitations require methotrexate to have been trialled before they can be started—the usual paediatric dosages of bDMARDs (listed in alphabetical order) are:
adalimumab (child 2 years or older and 10 kg to less than 15 kg: 10 mg; 15 kg to less than 30 kg: 20 mg; 30 kg or more: 40 mg) subcutaneously, every 2 weeks adalimumab adalimumab adalimumab
OR
etanercept (child 2 years or older) 0.8 mg/kg up to 50 mg subcutaneously, once weekly1. etanercept etanercept etanercept
The specialist will determine the appropriate approach to monitoring, screening for infection, and vaccination, based on the adverse effect profile of the drug and patient factors (eg disease activity, comorbidities). See also Principles of immunomodulatory drug use.