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We studied whether serum levels of <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic>, free or bound to etanercept, could predict long\u2010term efficacy of etanercept in children with <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included 41 biologic\u2010na\u00efve patients with <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content> who started treatment with etanercept at Sk\u00e5ne University Hospital between 1999 and 2010. Serum taken at the start of treatment and at the six\u2010week follow\u2010up were analysed for <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic> and the long\u2010term efficacy of etanercept was assessed using the drug survival time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Levels of <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic> increased significantly at the six\u2010week follow\u2010up, and this was almost exclusively comprised of <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic> in complex with etanercept. The increase in <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic> showed a dose\u2010dependent correlation to long\u2010term drug survival (p &lt; 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increasing levels of circulating <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic> at treatment initiation predicted long\u2010term efficacy of etanercept in children with <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>, which may have been due to different pathophysiological mechanisms of inflammation. Our result may provide a helpful clinical tool, as high levels of circulating <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010<jats:italic>\u03b1<\/jats:italic>\/etanercept complexes could be used as a marker for the long\u2010term efficacy of etanercept.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.13319","type":"journal-article","created":{"date-parts":[[2015,12,28]],"date-time":"2015-12-28T04:44:54Z","timestamp":1451277894000},"page":"427-432","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Circulating complexes between tumour necrosis factor\u2010alpha and etanercept predict long\u2010term efficacy of etanercept in juvenile idiopathic arthritis"],"prefix":"10.1111","volume":"105","author":[{"given":"Robin","family":"Kahn","sequence":"first","affiliation":[{"name":"Department of Pediatrics Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet","family":"Berthold","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitta","family":"Gullstrand","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Infection Medicine Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Geborek","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tore","family":"Saxne","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders A.","family":"Bengtsson","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bengt","family":"M\u00e5nsson","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Clinical Sciences Lund Lund University and Sk\u00e5ne University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60244-4"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature01661"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/icb.2013.15"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.014886"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.087411"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24777"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.60.7.660"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.174.6.1483"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780390105"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780380602"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400703"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24516"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204128"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"R174","DOI":"10.1186\/ar2084","article-title":"Impact of concomitant DMARD therapy on adherence to treatment with etanercept and infliximab in rheumatoid arthritis. 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