Background/Purpose: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry is a multicenter, prospective observational study collecting data from children with rheumatic diseases in order to characterize disease patterns, treatments, and outcomes. The current Registry began enrolling children with JIA in July 2015. This abstract describes patterns of medication use among children with JIA enrolled through March 31, 2016.

Methods: Children were enrolled into the CARRA Registry by participating centers in the US and Canada.  Children with the following characteristics were eligible for enrollment: 1) new diagnosis of JIA within previous 6 months; 2) systemic JIA; 3) history of polyarthritis (≥ 5 joints involved during disease course); 4) newly starting or re-starting methotrexate or biologic. In the categorization of medication use, current and past medication use were combined, and non-biologic DMARDs included methotrexate, leflunomide, and sulfasalazine. Patients with incomplete data entry at the time of analysis were included, and missing data were not imputed.

Results: 1155 children were enrolled from 46 centers; 244 were newly diagnosed (29% of those with sufficient data to determine). Patient characteristics are summarized in the Table. Receipt of non-biologic DMARDs only (without receiving biologics) was observed in 18% of all children, and there was an increased proportion of newly diagnosed patients in this group (30%). Receipt of any biologic agent was present in 56% of all children, and this was less common among patients with persistent oligoarthritis (30%). Non-TNF inhibitor biologic use was common among systemic JIA (71%) and was very uncommon among ERA (2%) and psoriatic arthritis (0%), although smaller numbers of children with these JIA categories have been enrolled into the Registry to date. Any use of systemic glucocorticoids was present among 44% overall, and was increased among systemic JIA (81%) and RF+ polyarthritis (69%). Among newly diagnosed children, 38% were treated with biologics, 30% had received DMARD only, and 29% received systemic glucocorticoids.

Conclusion: By design, this large cohort of children with JIA from North America includes a high proportion of biologic users. Children with systemic  JIA had the most frequent use of non-TNF inhibitor biologics and systemic glucocorticoids, consistent with treatment efficacy data. Longitudinal data generated from the long-term follow-up of Registry participants will provide important data on medication usage, as well as comparative safety and effectiveness.