Session Information
Date: Tuesday, November 7, 2017
Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster III: Juvenile Arthritis
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: To analyze the efficacy and safety of biologic agents in adult patients with juvenile idiopathic arthritis (JIA).
Methods:
ATTRA is a Czech national registry of patients with different forms of chronic arthritis who are treated with biologics. We have used this registry to evaluate treatment with TNF antagonists and other biologics in adult patients with juvenile idiopathic arthritis. Patients were treated with doses recommended for rheumatoid arthritis patients. Those patients, who failed to improve in DAS28 by at least 1.2 after 3 months at 2 consecutive visits, who lost the response during the treatment, or who had to be discontinued due to adverse event, were switched to alternative TNF inhibitor or other biologic drug. Clinical efficacy was assessed by the improvement in DAS28 and by assessment of quality of life using standard questionnaires (HAQ, SF36). Survival on therapy with biologic agent was calculated. Safety assessments were done for all patients during the whole follow-up period in 3 months intervals.
Results:
There are 419 adult patients with JIA followed in the ATTRA registry. Seventy-four started the treatment with biologic before 16 year of age; the remaining 345 commenced biologics in adult age. Valid and complete data for analysis are available in 275 patients, who have begun treatment in adulthood.
At the start of the treatment with biologics the mean age was 27±9 years, duration of disease 16±10 years and 73.8% were females. Mean age at the diagnosis was 11±6 years.
Patients were of the following subtypes of JIA: JIA RF negative 28.3%, JIA RF+ 22.8%, enthesitis related arthritis 18.9%, extended oligoarthritis 12.2%, psoriatic arthritis 7.2%, systemic onset 6,1% and persistent oligoarthritis 4.4%. The first biologic was either infliximab (37.1%), or etanercept (26.2%), adalimumab 27.6%), golimumab (4.4%), certolizumab (2.5%), tocilizumab (1.5%), abatacept (0,4%) and rituximab (0.4%).
Efficacy of the first biologic (DAS28):
|
DAS28
|
Before treatment |
3 months |
1 year |
5 years |
10 years |
|
Mean±SD
|
5.7±1.0 |
3.1±1.1 |
2.8±1.2 |
2.4±1.1 |
2.5±1.4 |
|
Median 5.; 95.perc |
5.7 (4.0; 7.2) |
3.0 (1.4; 5.2) |
2.7 (1.2; 4.9) |
2.2 (1.1; 4.5) |
2.1 (1.2;6.0) |
|
Remission
|
2 (0.7%) |
82 (34.2%) |
91 (47.6%) |
61 (64.2%) |
23 (69.7%) |
|
LDA
|
4 (1.5%) |
56 (23.3%) |
36 (18.8%) |
15 (15.8%) |
3 (9.1%) |
|
Number of patients |
275 |
240 |
191 |
95 |
33 |
Efficacy of long term treatment including switches (DAS28):
|
DAS28 |
Before treatment |
3 month |
1 year |
5 years |
10 years |
|
Mean±SD |
5.7±1.0 |
3.1±1.2 |
2.9±1.3 |
2.7±1.3 |
2.8±1.4 |
|
Median 5.; 95.perc |
5.7 (4.0; 7.2) |
3.1 (1.4; 5.2) |
2.8 (1.2; 5.3) |
2.5 (1.2; 5.4) |
2.4 (1.2;6.0) |
|
Remission |
2 (0.7%) |
83 (33.5%) |
96 (45.1%) |
86 (51.8%) |
40 (53.3%) |
|
LDA |
4 (1.5%) |
56 (22.6%) |
42 (19.7%) |
25 (15.1%) |
13 (17.3%) |
|
Number of patients |
275 |
248 |
213 |
166 |
75 |
Conclusion:
A significant number of adult JIA patients benefit from long-term treatment with biological agents. DAS28 showed excellent and persistent improvement for patients maintaining first biologic up to 10 years. Treatment effect to second and other biologic agents was only slightly smaller and contributed to a very good persistence on the treatment. The effect on activity was mirrored also in the functional improvements assessed by HAQ.
Supported by Research Project from Ministry of Health in the Czech Republic No: 000 000 23728
To cite this abstract in AMA style:
Jarosova K, Szczukova L, Kristkov Z, Vencovsky J. Treatment of Adult Juvenile Idiopathic Arthritis Patients with Biologic Agents. Data from the National Registry [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/treatment-of-adult-juvenile-idiopathic-arthritis-patients-with-biologic-agents-data-from-the-national-registry/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-adult-juvenile-idiopathic-arthritis-patients-with-biologic-agents-data-from-the-national-registry/