Pediatrik Romatoloji Hastalarında Biyolojik Ajanlara Bağlı Reaksiyonların Klinik Özellikleri: Tek Merkez Deneyimi

Ankara Şehir Hastaneleri 3. Pediatri Kongresi, Ankara, Türkiye, 8 - 10 Ekim 2026, ss.213-214, (Özet Bildiri)

Yayın Türü: Bildiri / Özet Bildiri
Basıldığı Şehir: Ankara
Basıldığı Ülke: Türkiye
Sayfa Sayıları: ss.213-214
Kocaeli Üniversitesi Adresli: Evet

Özet

Objective: Childhood rheumatic diseases encompass various conditions with different clinical features, including juvenile idiopathic arthritis(JIA), familial Mediterranean fever(FMF),systemic lupus erythematosus(SLE),and systemic vasculitides. Biologic agents are effective treatments widely used in the management of pediatric rheumatic diseases. However, different reactions may develop during biologic agent use, ranging from local injection-site findings to systemic hypersensitivity. Data regarding the frequency, clinical characteristics, and management of these conditions in childhood are limited. This study aimed to evaluate the frequency and clinical characteristics of local and systemic reactions associated with biologic agents in pediatric rheumatology patients, as well as the treatment approaches applied following these events. Materials-Methods: Patients who received biologic agent therapy in our pediatric rheumatology clinic between January 2021 and June 2026 were included in the study. Demographic characteristics, primary rheumatologic diagnoses, biologic agent used,treatment duration, and route of administration, as well as local and systemic adverse events occurring during treatment, were retrospectively evaluated. Redness, swelling,pain,or itching at the injection site were defined as local reactions, whereas the development of urticaria,angioedema,bronchospasm,hypotension,and/or anaphylaxis was defined as a systemic reaction. Results: A total of 175 patients receiving biologic agents were included in the study;98(56.0%) patients were female. The primary diagnoses were JIA in 118(67.4%) patients, uveitis in 18(10.3%), FMF in 14(8.0%),Behçet’s disease in 6(3.4%), chronic nonbacterial osteomyelitis in 5(2.9%),SLE in 4(2.3%),and other rheumatic diseases in 10(5.7%)patients. Adverse events were observed in 16(9.1%) patients during biologic treatment. Ten of these were injection-site redness and/or itching associated with anakinra, occurring between days 7 and 25 of treatment. Treatment was switched to canakinumab in nine patients, while anakinra was continued in one patient because the symptoms did not recur following cold application and antihistamine treatment. Two patients receiving etanercept were switched to adalimumab due to injection-site redness and itching. In one patient receiving adalimumab, local redness regressed with antihistamine treatment, and the existing treatment was continued. Systemic events occurred in two patients during rituximab infusion. In a patient diagnosed with orbital myositis, anaphylaxis developed at the 90th minute of the infusion, and intramuscular adrenaline was administered; the subsequent dose was completed uneventfully using a desensitization protocol. In a patient with SLE, a feeling of chest tightness developed during the second hour of the infusion without any additional clinical findings. Following antihistamine and analgesic treatment, the infusion was completed, and no similar problem was observed during the subsequent administration. In addition, a patient with JIA developed headaches lasting three to four days following etanercept administrations and recurring for approximately three months. After excluding other possible causes, this was considered a drug-related adverse event, and the treatment was changed. Conclusion: Local injection-site reactions were the most frequently observed events during biologic agent use. Although switching the agent was preferred in most of these patients, the existing treatment could be continued with symptomatic approaches in mild cases. In rare but serious systemic reactions, appropriate emergency intervention and, when necessary, desensitization may allow treatment to be continued safely. These findings demonstrate that early recognition of adverse events associated with biologic agents and individualized management according to clinical severity are important for maintaining effective treatment.