Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
The management of juvenile idiopathic arthritis (JIA) has been revolutionised by the introduction of biologics such as etanercept (ETN), approved in the UK in 2002. Since that time, the use of biologics in children and young people (CYP) has expanded, including the use of those licensed for JIA (adalimumab (ADA), tocilizumab (TCZ), abatacept) as well as those licensed for rheumatoid arthritis (rituximab, infliximab (IFX) and anakinra (ANA)). ETN is most often the first choice biologic in the treatment of JIA; however there may be occasions where ETN is not the preferred choice, for reasons of either efficacy or safety. Understanding how biologics are being selected will help inform future practice and research. Therefore, the aim of this analysis was to describe the choice of first-line biologics in UK CYP with JIA and explore possible reasons behind this choice.
Methods:
Both the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN), established 2004, and the Biologics for Children with Rheumatic Diseases (BCRD) study, established 2010, are ongoing prospective observational cohorts, collecting detailed information on CYP starting either ETN (BSPAR-ETN) or any other biologic (BCRD) for JIA. At start of therapy, demographic and disease information is collected. Biologic-naive patients registered on or after 01/01/2010 starting their first biologic were identified and baseline disease characteristics compared between therapies, using descriptive statistics. An additional cohort of children starting ETN <2010 were also included to analyse changes in ETN prescribing since initial approval.
Results:
To 07/04/2014, 870 patients were recruited starting a first-line biologic (123 BCRD; 747 BSPAR-ETN (582<2010, 165≥2010) (Table). From 2010, children with systemic JIA (sJIA) were almost exclusively prescribed ANA or TCZ. Choice between anti-TNF therapies was largely driven by prevalence of uveitis (5% ETN versus 70% ADA and 72% INF). Children starting ETN were also more likely to have a polyarticular subtype. Only half of the patients starting ETN received concomitant methotrexate compared to the other biologics (69-90%). Compared to ETN patients pre-2010, CYP starting ETN from 2010 had shorter disease duration and were less likely to be receiving corticosteroids, have lesser prevalence of sJIA and lower rates of uveitis.
Conclusion:
Although ETN remains the most common biologic prescribed for JIA, there has been a clear shift towards the use of alternative biologics, including unlicensed biologics, in certain patient situations, largely driven by disease subtype and the presence of uveitis. This channelling of certain children towards specific therapies will need to be considered both in terms of future comparative effectiveness studies and also as a guide to ongoing research priorities within rheumatology.
|
*All values median(IQR) or n(%) |
Biologic Start post 01/01/2010 |
Pre-2010 |
||||
|
|
Etanercept |
Adalimumab |
Infliximab |
Tocilizumab |
Anakinra |
Etanercept |
|
N |
165 |
45 |
29 |
32 |
15 |
582 |
|
Female |
109 (67%) |
30 (67%) |
17 (59%) |
14 (44%) |
11 (73%) |
384 (66%) |
|
Age, years |
11 (8, 14) |
10 (6, 14) |
8 (5, 10) |
8 (4, 11) |
3 (2, 13) |
11 (8, 14) |
|
Disease Duration, years |
2 (1, 5) |
4 (2, 6) |
3 (2, 6) |
1 (1, 2) |
0 (0, 1) |
4 (2, 7) |
|
ILAR subtype |
|
|
|
|
|
|
|
Systemic arthritis |
5 (3%) |
1 (2%) |
1 (3%) |
28 (88%) |
15 (100%) |
70 (12%) |
|
Oligoarthritis: persistent |
13 (8%) |
14 (31%) |
8 (28%) |
0 |
0 |
15 (3%) |
|
Oligoarthritis: extended |
26 (16%) |
10 (22%) |
8 (28%) |
0 |
0 |
102 (18%) |
|
Polyarthritis: RF(-) |
66 (40%) |
7 (16%) |
9 (31%) |
3 (9%) |
0 |
195 (34%) |
|
Polyarthritis: RF(+) |
17 (10%) |
2 (4%) |
0 |
0 |
0 |
58 (10%) |
|
Enthesitis Related Arthritis |
10 (6%) |
5 (11%) |
2 (7%) |
0 |
0 |
50 (9%) |
|
Psoriatic arthritis |
10 (6%) |
5 (11%) |
1 (3%) |
0 |
0 |
44 (8%) |
|
Undifferentiated arthritis |
6 (4%) |
0 |
0 |
1 (3%) |
0 |
39 (7%) |
|
Not Recorded |
12 (7%) |
1 (2%) |
0 |
0 |
0 |
9 (2%) |
|
Concomitant MTX |
77 (47%) |
31 (69%) |
26 (90%) |
28 (88%) |
12 (80%) |
322 (55%) |
|
Concomitant Corticosteroids |
15 (9%) |
7 (16%) |
5 (17%) |
23 (72%) |
7 (47%) |
146 (25%) |
|
Ever had Chronic Anterior Uveitis |
7 (5%) |
31 (70%) |
21 (72%) |
0 |
0 |
54 (11%) |
|
Disease activity |
|
|
|
|
|
|
|
Active joint count |
5 (2, 9) |
2 (0, 4) |
2 (0, 5) |
3 (0, 6) |
5 (2, 12) |
5 (2, 10) |
|
Limited joint count |
3 (1, 8) |
2 (0, 3) |
0 (0, 5) |
2 (0, 5) |
3 (0, 13) |
5 (2, 9) |
|
Physician Global Assessment (10cm VAS) |
3 (2, 5) |
3 (1, 4) |
2 (1, 4) |
3 (0, 6) |
4 (2, 6) |
4 (2, 6) |
|
Parent Global Assessment (10cm VAS) |
4 (1, 6) |
3 (1, 6) |
3 (0, 5) |
4 (1, 8) |
5 (4, 5) |
5 (2, 7) |
|
CHAQ [0-3] |
1 (0, 2) |
1 (0, 1) |
0 (0, 1) |
1 (0, 2) |
2 (1, 2) |
1 (0, 2) |
|
Pain (10cm VAS) |
4 (1, 7) |
3 (1, 7) |
4 (2, 5) |
3 (1, 6) |
6 (4, 6) |
5 (2, 7) |
|
ESR, mm/hr |
10 (5, 25) |
7 (5, 34) |
8 (4, 14) |
39 (9, 54) |
58 (8, 96) |
18 (7, 40) |
|
JADAS-71 |
13 (8, 21) |
10 (7, 17) |
6 (3, 12) |
19 (1, 22) |
23 (7, 30) |
16 (9, 23) |
Disclosure:
R. Davies,
None;
L. Kearsley-Fleet,
None;
E. Baildam,
Roche Pharmaceuticals,
9;
M. W. Beresford,
None;
H. E. Foster,
Pfizer Inc,
9,
Abbott Immunology Pharmaceuticals,
9,
Roche Pharmaceuticals,
9,
Novartis Pharmaceutical Corporation,
9;
T. R. Southwood,
None;
W. Thomson,
None;
K. L. Hyrich,
Pfizer Inc,
9,
Abbott Immunology Pharmaceuticals,
9;
O. B. O. T. BSPAR Etanercept Cohort Study,
Pfizer Inc,
2;
T. Biologics for Children with Rheumatic Diseases (BCRD) study,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-choice-of-first-biologic-among-children-with-juvenile-idiopathic-arthritis-a-combined-analysis-from-2-uk-paediatric-biologic-registers/