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 a chronic arthritis with onset before 16 years of age, that persists for at least 6 weeks, and has an unknown etiology.1 Uveitis is a serious and common extra-articular manifestation of JIA, affecting 12-30% of patients (most commonly female patients with the antinuclear antibody-positive oligoarthritis subtype of JIA).2,3 First-line treatment for JIA-associated uveitis is usually topical corticosteroids and/or conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), such as methotrexate (MTX). Biologic DMARDS (bDMARDs), such as the TNF inhibitors etanercept (ETN) and adalimumab (ADA), are used after failure of first-line treatments.2 However, it has been reported that ETN use is associated with uveitis flares or new-onset uveitis4 while a recent observational study reported similar uveitis flare rates for both ADA and ETN.5 The objective of this study was to analyze the occurrence of uveitis in patients with JIA treated with ETN, ADA, or MTX (as monotherapy and as part of combination therapy).
Methods: International Statistical Classification of Diseases (ICD)-9 diagnosis codes in a Truven MarketScan claims database were used to identify JIA patients diagnosed with uveitis over a 5-year interval. The analysis assessed the proportion of JIA patients (aged 0-19 years) treated with ETN, ADA, or MTX, as monotherapy or in combination. The percentage of patients diagnosed with uveitis and the time interval for uveitis diagnosis in JIA patients were determined.
Results: A total of 22,789 patients with JIA were included in this analysis. Mean age was 11.4 years, 69% of patients were female, and mean JIA disease duration was 3 years. This patient population included 19,814 patients with chronic, or not otherwise specified, polyarticular JIA. A total of 2581 (11.3%) patients (mean age 10.2 years, 73% female) were diagnosed with uveitis. There was no apparent difference in the percentage of JIA patients receiving ETN, ADA, or MTX who were diagnosed with uveitis. A total of 2.7-5.9% of patients receiving monotherapy were diagnosed with uveitis compared with 3.2-3.6% of patients receiving combination therapy (Figure). The vast majority of patients (2123 of 2581, 82.3%) with uveitis were diagnosed within a year of their JIA diagnosis.
Conclusion: In this patient database, a similar proportion of patients with JIA who were treated with ETN or ADA (either as monotherapy or in combination with MTX) received a subsequent diagnosis of uveitis.
References
1. Petty RE, et al. J Rheumatol 2004;31:390-2.
2. Clarke SL, et al. Pediatr Rheumatol Online J 2016;14:27.
3. Wentworth BA, et al. F1000Prime Rep 2014;6:41.
4. Schmeling H, et al. Rheumatology (Oxford) 2005;44:1008-11.
5. Foeldvari I, et al. Arthritis Care Res (Hoboken) 2015;67:1529-35.
To cite this abstract in AMA style:
Roshak K, Sopczynski JM, Suehiro R, Marshall L. Etanercept, Adalimumab and Methotexate Utilization By Juvenile Idopathic Arthritis Patients and the Occurrence of Uveitis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/etanercept-adalimumab-and-methotexate-utilization-by-juvenile-idopathic-arthritis-patients-and-the-occurrence-of-uveitis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/etanercept-adalimumab-and-methotexate-utilization-by-juvenile-idopathic-arthritis-patients-and-the-occurrence-of-uveitis/