Journal article
Biologic Switching Among Nonsystemic Juvenile Idiopathic Arthritis Patients: A Cohort Study in the Childhood Arthritis and Rheumatology Research Alliance Registry
Journal of rheumatology, Vol.48(8), pp.1322-1329
09/15/2020
DOI: 10.3899/jrheum.200437
PMID: 32934124
Abstract
Biologic medications have significantly improved disease control and outcomes of patients with juvenile idiopathic arthritis ( JIA). Current treatment recommendations suggest escalating therapy, including changing biologics if needed, when inactive or low disease activity is not attained. The patterns and reasons for switching biologics in clinical practice in North America are not well described.
We used the Childhood Arthritis and Rheumatology Research Alliance Registry and included individuals with JIA if they newly started a biologic after January 1, 2008, and had at least 12 months of subsequent observable time. Subjects with systemic JIA were excluded. We compared characteristics of switchers and nonswitchers using chi-square for categorical variables and Wilcoxon rank-sum test for continuous variables, and used linear regression for time analysis.
Of the eligible children, 1361 with JIA in the registry started a biologic (94% tumor necrosis factor inhibitors [TNFi]). Median followup time was 30 months and 349 (26%) switched biologics. Among biologic switchers, ineffectiveness/disease flare was the most common reason for switch (202, 58%). The most common documented switch was from etanercept to another TNFi (221, 63%). The median time to switch to a second biologic decreased substantially from 55.2 months in 2008 to 7.2 months in 2016.
In a multicenter cohort of patients with JIA starting a biologic, one-quarter switched to a second biologic, and the time to switching decreased in recent years. Additional studies should evaluate the outcomes and optimal timing of switching and preferred sequence of biologic use.
Details
- Title: Subtitle
- Biologic Switching Among Nonsystemic Juvenile Idiopathic Arthritis Patients: A Cohort Study in the Childhood Arthritis and Rheumatology Research Alliance Registry
- Creators
- Melissa L Mannion - University of Alabama at BirminghamFenglong Xie - University of Alabama at BirminghamDaniel B Horton - Rutgers, The State University of New JerseySarah Ringold - Seattle Children'sColleen K Correll - University of MinnesotaAnne Dennos - Duke UniversityTimothy Beukelman - University of Alabama at BirminghamCARRA Registry Investigators
- Contributors
- S Lieberman (Contributor) - University of Iowa, Rheumatology, Allergy, and Immunology
- Resource Type
- Journal article
- Publication Details
- Journal of rheumatology, Vol.48(8), pp.1322-1329
- DOI
- 10.3899/jrheum.200437
- PMID
- 32934124
- ISSN
- 0315-162X
- eISSN
- 1499-2752
- Language
- English
- Date published
- 09/15/2020
- Academic Unit
- Stead Family Department of Pediatrics; Rheumatology, Allergy, and Immunology
- Record Identifier
- 9984354035502771
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