ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2284

Use of Biological Therapies in Adult Patients Diagnosed with Juvenile Idiopathic Arthritis: Results from the Spanish Registry of Adverse Events with Biologic Therapies (BIOBADASER)

Carlos Sánchez-Piedra1, Rosa Rosello2, Javier Manero3, M. Victoria Hernández4, Fernando Sánchez-Alonso5, Eduardo Cuende6, Blanca García Magallon3, Ana M. Ortiz Garcia7, Cesar Diaz-Torné8, Mercedes Freire9, Paloma Vela10, Raúl Menor Almagro11, Agueda Prior12, Federico Díaz-González13, Juan J. Gomez-Reino14 and Sagrario Bustabad15, 1Research Unit, Spanish Society of Rheumatology, Madrid, Spain, 2Hospital San Jorge, Huesca, Spain, 3Rheumatology, Hospital Miguel Servet, Zaragoza, Spain, 4Rheumatology Service, Hospital Clínic de Barcelona, Barcelona, Spain, 5Unidad de Investigación, Spanish Society of Rheumatology, Madrid, Spain, 6University Hospital Príncipe de Asturias, Immune System Diseases, Rheumatology department, Alcalá de Henares, Madrid, Spain, 7Rheumatology, Rheumatology Service, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain, 8GEACSER, Madrid, Spain, 9Servicio de Reumatología. Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo HospitalarioUniversitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain, 10Reumatología, Hospital General Universitario de Alicante. Alicante. Spain, Alicante, Spain, 11Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain, 12Rheumatology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, 13Servicio de Reumatología. Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, 14Fundacion Ramon Dominguez, Hospital Clinico Universitario, Santiago de Compostela, Spain, 15Rheumatology, Servicio de Reumatología. Hospital Universitario de Canarias, La Laguna, Tenerife, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Tuesday, November 7, 2017

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster III: Juvenile Arthritis

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. The advent of new biological drugs has changed the prognosis and therapeutic approach to these patients. Our aim was to evaluate the use of biological therapy in JIA.

Methods:

Multicenter prospective study. Information was obtained from BIOBADASER. All patients diagnosed before age 16 in our database between 2000 and 2015 were included in the analysis. JIA is classified into 7 subgroups: systemic, persistent or extended oligoarthritis, RF positive polyarthritis, RF negative polyarthritis, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Due to the design of the registry, it was not possible to identify each of the JIA subgroups; thus, we classified them into systemic/oligo/polyarticular JIA, JIA related to enthesitis, and psoriatic JIA.

Proportions, means and standard deviations (SD) were used to describe our population and the utilization of treatments. Survival rates were calculated until termination of treatment for any reason.

Results: A total of 469 patients were classified as systemic/oligo/polyarticular JIA (70.6%), JIA related to enthesitis (25%) and psoriatic JIA (4.5%). 46.1% of patients were women (n= 216). Age at diagnosis was 9.4 (SD= 5.3) and years of disease evolution 24.1 (SD= 14.1). The age at biological treatment initiation was 23.9 years (SD= 13.9). 42.4% of the biologicals were used as monotherapy. Methotrexate was used in combination in 44.0% of the biological treatments. 12.4% of the patients received more than 3 biologicals (December 2015). The most commonly used drug was Etanercept (34.7%), followed by Infliximab (21.6%). Table 1 shows the biologic therapies used in our sample. 42.4% of the treatments with Etanercept were in monotherapy. The median survival rate with the drug was over three years (Table 2).

Conclusion: TNFi were the most commonly used biologic therapies in JIA. Ineffectiveness was the main reason for discontinuation. Survival rates can be a crucial endpoint in JIA, with age at initiation of biological treatment of particular concern.

Table 1. Biological and concomitant drugs used in patients with JIA.

Biologic drug

First-line Biologic

n (%)

Second-line Biologic

n (%)

All

n (%)

Etanercept

204 (43.5)

119 (25.8)

323 (34.7)

Infliximab

143 (30.5)

58 (12.6)

201 (21.6)

Adalimumab

89 (19.0)

108 (23.4)

197 (21.2)

Anakinra

8 (1.7)

15 (3.3)

23 (2.5)

Rituximab

0 (0.0)

72 (15.6)

72 (7.7)

Abatacept

5 (1.1)

28 (6.1)

33 (3.6)

Tocilizumab

16 (3.4)

40 (8.7)

56 (6.0)

Golimumab

2 (0.4)

13 (2.8)

15 (1.6)

Certolizumab

2 (0.4)

5 (1.1)

7 (0.8)

Canakinumab

0 (0.0)

2 (0.4)

2 (0.2)

Ustekinumab

0 (0.0)

1 (0.2)

1 (0.1)

Concomitant drugs

– Biological monotherapy

177 (37.7)

217 (47.1)

394 (42.4)

– Metotrexate

225 (48.0)

184 (39.9)

409 (44.0)

– Glucocorticoids

155 (33.1)

145 (31.5)

300 (32.3)

Table 2. Drug Survival Rates in patients with JIA in BIOBADASER Phase II. Discontinuation reasons.

Supervivencia (IC95%)

First-line biologic

Second-line Biologic

All

1st year

0.809 (0.771-0.842)

0.723 (0.659-0.777)

0.797 (0.758-0.830)

2nd year

0.678 (0.634-0.719)

0.558 (0.493-0.618)

0.652 (0.609-0.691)

3rd year

0.586 (0.540-0.630)

0.418 (0.359-0.475)

0.542 (0.500-0.583)

4th year

0.516 (0.469-0.561)

0.352 (0.298-0.406)

0.462 (0.421-0.502)

5th year

0.482 (0.434-0.527)

0.274 (0.227-0.323)

0.397 (0.358-0.435)

6th year

0.434 (0.387-0.480)

0.210 (0.170-0.253)

0.341 (0.305-0.377)

7th year

0.393 (0.346-0.440)

0.169 (0.134-0.208)

0.286 (0.253-0.320)

8th year

0.369 (0.322-0.417)

0.134 (0.103-0.169)

0.243 (0.213-0.275)

Discontinuation reasons

n (%)

n (%)

n (%)

Ineffectiveness or loss

106 (37.3)

126 (42.4)

232 (39.9)

Adverse event

80 (28.2)

61 (20.5)

141 (24.3)

Pregnancy or gestational desire

13 (4.6)

14 (4.7)

27 (4.7)

Loss of follow-up

24 (8.5)

8 (2.7)

32 (5.5)

Remission

35 (12.3)

9 (3.0)

44 (7.6)

Others

24 (8.5)

73 (24.6)

97 (16.7)

Unknown

2 (0.7)

6 (2.0)

8 (1.4)

Total

284

297

581

Disclosure: C. Sánchez-Piedra, None; R. Rosello, None; J. Manero, None; M. V. Hernández, None; F. Sánchez-Alonso, None; E. Cuende, None; B. García Magallon, None; A. M. Ortiz Garcia, None; C. Diaz-Torné, None; M. Freire, None; P. Vela, None; R. Menor Almagro, None; A. Prior, None; F. Díaz-González, None; J. J. Gomez-Reino, AbbVie, MSD, Pfizer Inc, Roche, 2,Pfizer Inc, 5,AbbVie, Biogen, Bristol-Myers Squibb, Janssen, MSD, Pfizer Inc, Roche, 8; S. Bustabad, Gebro, 2.

To cite this abstract in AMA style:

Sánchez-Piedra C, Rosello R, Manero J, Hernández MV, Sánchez-Alonso F, Cuende E, García Magallon B, Ortiz Garcia AM, Diaz-Torné C, Freire M, Vela P, Menor Almagro R, Prior A, Díaz-González F, Gomez-Reino JJ, Bustabad S. Use of Biological Therapies in Adult Patients Diagnosed with Juvenile Idiopathic Arthritis: Results from the Spanish Registry of Adverse Events with Biologic Therapies (BIOBADASER) [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/use-of-biological-therapies-in-adult-patients-diagnosed-with-juvenile-idiopathic-arthritis-results-from-the-spanish-registry-of-adverse-events-with-biologic-therapies-biobadaser/. Accessed .

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