Q: I heard something about a revolutionary new drug for treating children with rheumatoid arthritis. What is it?

Ask Our Expert About Humira for Children with Rheumatoid Arthritis

About Our Expert

C. April Bingham, M.D., is a pediatric rheumatologist at Lehigh Valley Health Network.

• I heard something about a "revolutionary" new drug for treating children with rheumatoid arthritis. What is it?
• What makes this new drug "revolutionary"?
• How does Humira work?
• Is this drug for every child with JRA?
• Are there any side effects?

Q: I heard something about a "revolutionary" new drug for treating children with rheumatoid arthritis. What is it?

A: What you’ve probably been hearing about is the drug Humira (adalimumab). Since 2002, this drug has been successfully used in adults with rheumatoid arthritis (RA). A new trial measuring its effectiveness and safety in juvenile rheumatoid arthritis (JRA) has recently been completed. The results were very promising, but the Federal Drug Administration (FDA) has not yet approved its use in children.

Q: What makes this new drug "revolutionary?"

A: The study found Humira to be extremely effective in treating joint pain, swelling, and stiffness and preventing “flare-ups,” or times when symptoms are particularly severe. Physicians who reviewed the trial results expect that children will be able to lead more normal lives and escape most of the crippling effects of RA, even as they get older. That’s good news for the 1 in 1000 children with JRA.

Q: How does Humira work?

A: Humira belongs to a class of drugs called TNF blockers. Enbrel (etanercept) is another TNF blocker and is currently FDA approved for JRA. TNF (Tumor necrosis factor) is a chemical that is produced by the body’s immune system. In people with RA, TNF is overproduced and is the main regulator of inflammation. Because RA is an autoimmune disorder--in which the immune system attacks healthy tissues of the body--treatment involves suppressing the agents of the immune system that are causing harm. Studies have shown that blocking the action of TNF is beneficial in reducing inflammation.

Q: Is this drug for every child with JRA?

A: No. JRA includes many different disease subtypes. Some patients have chronic symptoms, whereas others have intermittent “flare-ups.” Some children have only one or a few affected joints, while others are more severely affected. Humira is a good option for children who have more significant disease. Other drugs such as Methotrexate may be adequate to control the arthritis in some children.

Q: Are there any side effects?

A: Because Humira affects the immune system, people receiving it are more prone to infections, but the incidence in the study was relatively low. We are still learning about the long-term side effects, because this class of drugs is new. There may be a very minimal risk of lymphoma or other types of cancer, but this appears to be very rare. At this point, the benefits clearly outweigh possible side effects in most cases. Humira prevents bony damage and disability that can occur in RA, so early treatment is important. We expect that the FDA will approve Humira for children with JRA in the near future.

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