Background/Purpose: Patients with incomplete response to initial anti-TNF treatment often are switched to other biologic treatments. However, little is known about the efficacy of switching to a second anti-TNF or a non-TNF biologic treatment since comparative clinical trials are lacking.

Methods: Data of the German BIKER registry were used to analyse treatment response after switching from a TNF-inhibitor to a second TNF-inhibitor or to a non-TNF-inhibitor biologic. Efficacy analyses were performed with the patients´ disease activity assessed by the Juvenile Arthritis Disease Activity Score (JADAS)-10 and functional status assessed by the Childhood Health Assessment Score-Disability Index (CHAQ-DI) as outcomes.

Results:

1725 JIA patients receiving Etanercept (ETA) as first biologic were identified in the BIKER registry. 279 patients received a second biologic, which was again a TNF-inhibitor in 219 (Adalimumab (ADA) 190, Infliximab (INF) 30, Golimumab (GOL) 5,) and a non-TNF inhibitor biologic in 60 cases (Abatacept (ABA) 16, Anakinra (ANA) 31, Tocilizumab (TOC) 13). Switchers more often had systemic JIA (15.1% vs 6.6%; p<0.001; Odd-R 2.5(1.7-3.7)) but less often enthesitis related arthritis (ERA) (9.7% vs.15. 9%; p=0.008, Odd-R 0.6 (0.4-0.9)) than non-switchers. Comparison of JADAS10 at last follow up to start of ETA gave a marked improvement of disease activity while a considerable residual disease activity persisted. 215 JIA patients had follow up forms after switching to a second biologic enabling the analysis of efficacy. After switching the biologic agent, a decrease of disease activity parameters could be observed in all cohorts. At last follow up, lowest JADAS10 (mean±SD) was reached in the patient cohort switching from ETA to ADA (6.2±6.1) followed by INF (9.7±9.9) and TOC (10.2±7.2). Patients on ABA had higher JADAS10 (12.5±10.2) at last follow up (table 1). Also the CHAQ-DI decreased in all cohorts. Lowest CHAQ-DI (mean±SD) was reached in patients switching from ETA to INF (0.21±0.52) or ADA (0.29±0.46), followed by TOC (0.4±0.67) and ABA (0.73±0.78). Follow-up data from few patients only switching to GOL and from patients switching to ANA (all but 3 systemic JIA) were not shown.

 

Switching from Etanercept to:	Time of analysis	JADAS-10	CHAQ-DI
Adalimumab  N=163	first on ETA	17.1+/-7.4	0.72+/-0.70
	last on ETA	8.4+/-7.0	0.40+/-0.54
	first on ADA	9.9+/-8,0	0.37+/-0.52
	last on ADA	6.2+/-6.1	0.29+/-0.46
Infliximab  N=19	first on ETA	19.4+/-8.0	1.03+/0.71
	last on ETA	10.9+/-9.5	0.44+/-0.58
	first on IFN	10.7+/-9.2	0.47+/-0.66
	last on IFN	9.7+/-9.9	0.21+/-0.52
Tocilizumab  N=20	first on ETA	18.9+/-6.0	0.93+/-0.85
	last on ETA	9.4+/-7.5	0.67+/-0.76
	first on TOC	13.2+/-10.0	0.75+/-0.72
	last on TOC	10.2+/-7.2	0.40+/-0.67
Abatacept  N=13	first on ETA	18.3+/-6.-3	0.68+/-0.56
	last on ETA	13.5+/-10.5	0.43+/-0.62
	first on ABA	17.4+/-6.5	0.57+/-0.51
	last on ABA	12.5+/-10.2	0.73+/-0.78

Conclusion:

JIA patients failing ETA can successfully be switched to another biologic. Interestingly, switching within the class of biologics, from a first TNF- to a second TNF-inhibitor also gave favourable results.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/second-tnf-inhibitor-or-alternative-biologic-in-juvenile-idiopathic-arthritis-jia-patients-failing-a-first-tnf-inhibitor/