Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
The range of biological drugs currently used in JIA therapy includes not only anti-TNF but also other varieties. However, despite the high effectiveness and good tolerability of biological agents, the first-line biological medication is discontinued in a certain cohort of children. The questions regarding effectiveness of switching to second-line and further biologics depending on the reasons for discontinuation of prior therapy and the acceptable number of drug switches still need to be solved. Purpose: To compare the effectiveness of adalimumab (ADA) therapy as the first-, second-, and third-line biological drug in children and adolescents with JIA.
Methods: A total of 214 juvenile patients were enrolled in this study: 120 ADA-naïve patients, 83 and 11 patients with a history of one and two drug switches, respectively. Response to therapy was assessed using the ACRPedi 30/50/70/90 criteria and the Wallace criteria. The treatment schedule and the reasons for discontinuation of prior biological medications were collected.
Eight patients received abatacept as the prior biological drug; 16 patients, etanercept; 64 patients, infliximab; 4 patients, rituximab; and 2 patients, tocilizumab. The predominant reasons for discontinuation of prior biological therapy were lack of primary effectiveness (16 (17%) patients) and partial ineffectiveness (39 (41.5%) patients); 14 patients (15%) had uveitis flare. In 8 patients (8.5%), therapy was discontinued because of adverse events; in 2 patients (2%), because of administrative reasons; and in 15 (16%) patients, because of stable remission. ADA therapy proved to be effective regardless of the number of prior biological drugs used. ACR90 was achieved by 75 (62.5%) ADA-naive patients and by 60 patients (63.8%) in the switching groups (p=0.841) within 1 year of treatment. Stable remission was achieved by 51 (42.5%) and 43 (45.7%) patients, respectively (p=0.635). However, the negative reasons for discontinuation of prior biological therapy are the risk factors for poor prognosis for response to therapy with different drugs. Among 57 children who discontinued the prior biological medication because of poor effectiveness, ADA was discontinued within the first year because of the same reason in 6 (10.5%) patients. Within this group, only 10 patients (17.5%) reached remission during the first year of ADA therapy and 32 patients (56.1%) reached ACR90.
Adalimumab is highly effective as the first-, second-, and third-line biological drug in children with JIA. Discontinuation of prior drug because of poor effectiveness reduces the chances for reaching stable remission and improvement in ACR90 during the first year of ADA therapy.
To cite this abstract in AMA style:Alexeeva E, Dvoryakovskaya T, Gladkikh V, Moskalev A, Denisova R, Isaeva K, Lomakina O, Soloshenko M, Karaseva A. Effectiveness of Switching to Adalimumab As the Second- and Third-Line Biological Drug in Patients with Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/effectiveness-of-switching-to-adalimumab-as-the-second-and-third-line-biological-drug-in-patients-with-juvenile-idiopathic-arthritis/. Accessed January 22, 2020.
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