Background/Purpose

To analyze the efficacy and safety of biologic agents in adult patients with juvenile idiopathic arthritis (JIA).

Methods

ATTRA is the Czech national registry of patients with different forms of chronic arthritis who are treated with biologic drugs. Using this registry, we have analyzed adult JIA patients, who switched their treatment between biologic agents. Patients were treated in recommended doses for RA and the first drug was infliximab (44.3%), etanercept (36.7%), adalimumab (18.1%), or golimumab (0.9%). Those patients, who failed to improve in DAS28 by at least 1.2 after 3 months at 2 consecutive visits, who lost the response during the treatment, or who had to be discontinued due to adverse event, were switched to an alternative TNF inhibitor (TNFi) or to rituximab, abatacept or tocilizumab. Survival on therapy after 1st and 2nd biologic agents was calculated. Clinical efficacy was assessed with DAS28. Safety assessments were done for all patients during the whole follow-up period. No guidelines have been issued for the preference between the 1^st or 2^nddrug type and this was left solely to treating physician decision and was based on the assessment of overall clinical situation.

Results

Two hundred and ten adult JIA patients were treated with anti-TNF agents in the 1^st instance. Mean age of patients was 22.4 years, duration of disease was 12.7 years and 62% were women. Ninety (42.9%) patients received more than one biologic agent. DAS28 showed excellent and persistent improvement for those patients who remained on the first drug. The treatment responses to a second biologic agent were also significant, although with smaller differences to baseline DAS28 values. DAS28 at the initiation of the first TNFi was 6.01±1.28 and decreased significantly to 2.69±1.47 after 12 months and to 2.21±1.46 after 24 months; DAS28 at initiation of the second TNFi or other biologic agent was 5.59±1.53 and decreased to 2.77±1.39 and 2.74±1.00 after 12 and 24 months, respectively. Survival on the treatment was shorter in patients who switched the biologic agent in comparison with the first users (p = 0.017).  The survival on the drug in first users and in switched patients was as follows:  0.93 (95% CI: 0.90-0.97) and 0.89 (95% CI: 0.82-0.95) in the first year; 0.87 (95% CI: 0.83-0.92) and 0.77 (95% CI: 0.68-0.86) in the second year. Adverse events that lead to treatment discontinuation were seen in 4% and 6% after one year and in 6% and 10% after 2 years therapy in the first and subsequent biologic agents groups, respectively. Treatment discontinuation due to inefficacy was observed in 1% and 6 %, and in 5% and 12% with the 1^st and 2^ndline treatment in years 1 and 2.

Conclusion

biologic treatment in adult patients with juvenile idiopathic is effective and safe. Similarly to patients with RA, it is possible to regain efficacy after switching to second biologic drug in a majority of patients, although with somewhat lower difference between the entry and 2 years DAS28 evaluations. Good adherence to therapy was observed for both first and second biologic agents.

Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 00023728 (Institute of Rheumatology)

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/biologic-treatment-of-adult-patients-with-juvenile-idiopathic-arthritis-followed-in-the-national-registry/