Session Information
Session Type: Abstract Submissions
Session Time: 5:30PM-7:00PM
Background/Purpose: We wondered if with our current physician based strategy we really do reach improvement within 3 months and inactive disease within 12 months in our JIA patients. We wanted to find out if we could find more objective criteria to guide the decision making for escalation to or switching anti-TNF.
Methods: We built a research data platform with which we extracted pseudonymized data from our electronic medical records. We included JIA patients in our center that started methotrexate, etanercept or adalimumab for the first time for their active JIA from 2008 till August 2015.
Results: Our RDP retrieved the data of 127 JIA-patients for the first time starting with methotrexate, 28 patients starting with adalimumab and 61 patients starting with etanercept. From these patients we could not always retrieve the JADAS-scores because of missing patient/parent VAS or ACR recommendation parameters. The number of active joints however was present at all visits. The baseline characteristics (table 1) showed as expected that the age and disease duration in the MTX-group is significantly lower compared to the anti-TNF groups. There was no significant difference between the ANA-status, JIA-subtypes, but when an anti-TNF agent was started in the presence of uveitis adalimumab was clearly favorite. Also the development of uveitis under anti-TNF therapy was significantly different. Following the intention-to-treat principle, 0 active joints in 12 months was reached by patients starting methotrexate, adalimumab and etanercept in 87.9%, 96.2% and 77.8% respectively. Figure 1 shows the percentage of patients reaching 0 active joints in time. The median time to reach inactive joint took 210 days for MTX, 95 days for adalimumab and 157 days for etanercept.
Table 1
|
|
MTX |
Adalimumab |
Etanercept |
Total |
||||
|
N (%) |
127 |
28 |
61 |
216 |
||||
|
Characteristics |
|
|
|
|
||||
|
Sex, female (%) |
88 |
(69,3) |
21 |
(75,0) |
38 |
(62,3) |
38 |
(17,6) |
|
Mean age at onset (sd) |
7,2 |
(4,3) |
6,8 |
(4,5) |
5,6 |
(4,2) |
6,7 |
(4,4) |
|
Mean age at start (sd) |
8,4 |
(4,8) |
10,5 |
(5,3) |
9,6 |
(4,8) |
9 |
(4,9) |
|
Mean disease duration at start (sd) |
1,3 |
(2,2) |
3,8 |
(4,0) |
4,0 |
(4,0) |
2,4 |
(3,3) |
|
ANA+ (%) |
21 |
(16,5) |
5 |
(17,9) |
14 |
(23,0) |
40 |
(18,5) |
|
HLA-B27+ (%) |
9 |
(7,1) |
4 |
(14,3) |
3 |
(4,9) |
16 |
(7,4) |
|
Uveitis at medication start (%) |
8 |
(6,3) |
7 |
(25,0) |
2 |
(3,3) |
17 |
(7,9) |
|
|
|
|
|
|
|
|
|
|
|
Subtype of JIA |
|
|
|
|
|
|
|
|
|
Oligo-articular (%) |
62 |
(48,8) |
12 |
(42,9) |
26 |
(42,6) |
100 |
(46,3) |
|
Persistent (%) |
18 |
(29,0) |
5 |
(41,7) |
15 |
(57,7) |
38 |
(38,0) |
|
Extended (%) |
44 |
(71,0) |
7 |
(58,3) |
11 |
(42,3) |
62 |
(62,0) |
|
Poly-articular RF- (%) |
51 |
(40,2) |
12 |
(42,9) |
30 |
(49,2) |
93 |
(43,1) |
|
Poly-articular RF+ (%) |
9 |
(7,1) |
1 |
(3,6) |
4 |
(6,6) |
14 |
(6,5) |
|
Psoriatic Arthritis (%) |
5 |
(3,9) |
3 |
(10,7) |
1 |
(1,6) |
9 |
(4,2) |
|
|
|
|
|
|
|
|
|
|
|
Medication history |
|
|
|
|
|
|
|
|
|
Previous DMARD usage (%) |
41 |
(32,3) |
28 |
(100,0) |
60 |
(98,4) |
129 |
(59,7) |
|
IA steroids (%) |
31 |
(24,4) |
12 |
(42,9) |
32 |
(52,5) |
75 |
(34,7) |
|
IA moments (mean, st dev) |
1,5 |
(0,9) |
2,9 |
(3,1) |
2,6 |
(2,1) |
2,2 |
(2,0) |
|
MTX (%) |
n/a |
28 |
(100) |
60 |
(98,4) |
88 |
(40,7) |
|
|
Duration in months (mean, st dev) |
|
|
24,6 |
(28,7) |
23,9 |
(29,2) |
24,2 |
(28,9) |
|
Leflunomide (%) |
0 |
(0) |
2 |
(7,1) |
9 |
(14,8) |
11 |
(5,1) |
|
Duration in months (mean, st dev) |
|
|
9,7 |
(8,9) |
21,2 |
(26,3) |
19,1 |
(24,1) |
|
Sulfasalazine (%) |
4 |
(3,1) |
2 |
(7,1) |
6 |
(9,8) |
12 |
(5,6) |
|
Duration in months (mean, st dev) |
5,5 |
(1,4) |
6,6 |
(4,2) |
11,7 |
(12,9) |
8,8 |
(9,3) |
|
Prednisolon (%) |
0 |
(0) |
4 |
(14,3) |
9 |
(14,8) |
13 |
(6,0) |
|
Duration in months (mean, st dev) |
|
|
11,3 |
(9, 5) |
4,2 |
(3,0) |
6,4 |
(6,4) |
|
|
|
|
|
|
|
|
|
|
|
Co-medication |
|
|
|
|
|
|
|
|
|
MTX (%) |
127 (100) |
21 |
(75,0) |
41 |
(67,2) |
62 |
(28,7) |
|
|
Leflunomide (%) |
0 |
(0) |
2 |
(7,1) |
3 |
(4,9) |
5 |
(2,3) |
|
Sulfasalazine (%) |
0 |
(0) |
1 |
(3,6) |
0 |
(0,0) |
1 |
(0,5) |
|
Prednisolon (%) |
3 |
(2,4) |
2 |
(7,1) |
6 |
(9,8) |
11 |
(5,1) |
|
|
|
|
|
|
|
|
|
|
|
Adverse event |
|
|
|
|
|
|
|
|
|
Uveitis developed under therapy (%) |
6 |
(4,7) |
0 |
(0) |
5 |
(8,2) |
11 |
(5,1) |
Figure 1.
Conclusion: On the basis of the results of this study, we can state that with the start of anti-TNF JIA improvement is indeed reached within 3 months and remission has been reached by 12 months in the majority. No significant difference is found between adalimumab or etanercept. MTX as concomitant medication is significantly less used with etanercept then with adalimumab. The reason for the physician-based decision to escalate to anti-TNF or not is now under analysis.
To cite this abstract in AMA style:
Swart J, Wulffraat N, de Roock S, van Dijkhuizen P. The real-world decisive reasons for drug-escalation and treatment results of synthetic and biological therapy in JIA [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 4). https://acrabstracts.org/abstract/the-real-world-decisive-reasons-for-drug-escalation-and-treatment-results-of-synthetic-and-biological-therapy-in-jia/. Accessed .« Back to 2017 Pediatric Rheumatology Symposium
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-real-world-decisive-reasons-for-drug-escalation-and-treatment-results-of-synthetic-and-biological-therapy-in-jia/