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Abstract Number: 405

Patterns of Medication Use in Children with Juvenile Idiopathic Arthritis: Results from the Childhood Arthritis & Rheumatology Research Alliance Registry

Sarah Ringold1, Yukiko Kimura2, Laura E. Schanberg3, Marc D. Natter4, Fenglong Xie5, Norman Ilowite6, Jason Jones7, Kelly Mieszkalski8, Timothy Beukelman9 and for the CARRA Registry Investigators, 1Pediatrics, Seattle Children's Hospital, Seattle, WA, 2Hackensack University Medical Center, Hackensack, NJ, 3Pediatrics, Duke Medical Center, Durham, NC, 4Intelligent Health Labs, Children's Hospital Boston, Boston, MA, 5Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 6Division of Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY, 7Childhood Arthritis and Research Rheumatology Alliance (CARRA), Durham, NC, 8Childhood Arthritis and Rheumatology Research Alliance (CARRA), Durham, NC, 9Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Juvenile Arthritis, juvenile idiopathic arthritis (JIA), medication and registry

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Session Information

Date: Sunday, November 13, 2016

Session Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster I: Juvenile Idiopathic Arthritis, Uveitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

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.

 

 

Frequency (%) or Median (25-75%)

Characteristic

All Patients

Disease Duration > 6 Months

Disease Duration ≤  6 Months

Number of patients

1155

609

244

Age at enrollment (years)

13.4 (8-16)

12.9 (8.7 – 16.2)

10.2 (5.1-14.2)

Female

866 (75)

457 (75)

177 (73)

White race

829 (81)

483 (82)

185 (82)

Private health insurance

762 (74)

452 (76)

178 (75)

Disease duration (years)

2.1 (0.4-5)

3.7 (1.7 – 6.7)

0.1 (0-0.3)

ILAR category:

 

 

 

Oligoarthritis, persistent

125 (12)

47 (8)

70 (29)

Oligoarthritis, extended

76 (7)

52 (9)

6 (4)

Polyarthritis, RF-

436 (42)

282 (46)

64 (27)

Polyarthritis, RF+

93 (9)

65 (11)

16 (7)

Psoriatic arthritis

51 (5)

23 (4)

19 (8)

Enthesitis related arthritis

90 (9)

36 (6)

39 (16)

Systemic arthritis

149 (14)

96 (16)

25 (10)

Undifferentiated arthritis

11 (1)

8 (1)

2 (1)

ANA+

381 (33)

232 (38)

79 (32)

RF+

98 (8)

65 (11)

20 (8)

Anti-cyclic citrullinated peptide antibody

79 (7)

49 (8)

17 (7)

HLA-B27+

78 (7)

42 (7)

22 (9)

Polyarthritis course (≥ 5 joints involved during disease course)

772 (67)

498 (82)

121 (50)

Uveitis ever

91 (8)

62 (10)

1 (0.4)

Non-biologic use only

213 (18)

108 (18)

73 (30)

Any biologic use

650 (56)

426 (70)

93 (38)

Non-TNF inhibitor biologic use

180 (16)

120 (20)

18 (7)

Systemic glucocorticoid use

503 (44)

344 (56)

71 (29)

 



Disclosure: S. Ringold, None; Y. Kimura, Novartis, SOBI, 5,CARRA, Inc (salary support), 9; L. E. Schanberg, None; M. D. Natter, None; F. Xie, None; N. Ilowite, SOBI, 5,Novartis Pharmaceutical Corporation, 5; J. Jones, None; K. Mieszkalski, None; T. Beukelman, Novartis Pharmaceutical Corporation, 5,UCB, 5.

To cite this abstract in AMA style:

Ringold S, Kimura Y, Schanberg LE, Natter MD, Xie F, Ilowite N, Jones J, Mieszkalski K, Beukelman T. Patterns of Medication Use in Children with Juvenile Idiopathic Arthritis: Results from the Childhood Arthritis & Rheumatology Research Alliance Registry [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/patterns-of-medication-use-in-children-with-juvenile-idiopathic-arthritis-results-from-the-childhood-arthritis-rheumatology-research-alliance-registry/. Accessed March 1, 2021.
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