Approach to switching biologics in juvenile idiopathic arthritis: a real-life experience

Karadağ, Şerife Gül; Demirkan, Fatma Gül; Koç, Rahime; Çakmak, Figen; Sönmez, Hafize Emine; Ayaz, Nuray Aktay

doi:10.1007/s00296-021-04854-y

Cited by 4 publications

(8 citation statements)

References 17 publications

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“…Among all b-DMARDs prescribed ( n = 199) for 147 children with JIA, etanercept (70%), adalimumab (34%), and tocilizumab (12%) were the most common. These findings are similar to frequencies observed in other recent studies [ 11 , 19 , 20 ]. However, rituximab prescriptions were observed in a study conducted in the UK, but not in our cohort [ 10 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, rituximab prescriptions were observed in a study conducted in the UK, but not in our cohort [ 10 ]. When examining the switching patterns among b-DMARDs, similar to the studies recently published, we also observed that first and second choice for b-DMARDs are generally TNFi therapies [ 10 , 11 ].…”

Section: Discussionsupporting

confidence: 78%

“…Treatment patterns may vary by setting, depending on the approval and accessibility of medications and guidelines. There is very limited recent evidence on prescription patterns in JIA, with only two studies evaluating the frequency and outcomes of b-DMARD switching in patients with JIA after 2010: one in the United Kingdom and another in Turkey [ 10 , 11 ]. However, a gap remains regarding the description of current real-world prescription patterns of both c-DMARDs and b-DMARDs, and particularly, a lack of treatment trajectory assessment.…”

Section: Introductionmentioning

confidence: 99%

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Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study

et al. 2022

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Objective Pharmacological treatment is a cornerstone of care for children with juvenile idiopathic arthritis (JIA). The objective of this study is to evaluate prescription patterns of conventional and biologic disease modifying anti-rheumatic drugs (c-DMARDs and b-DMARDs) for patients with JIA. Methods We conducted a retrospective cohort study of children diagnosed with JIA at a rheumatology pediatric clinic. Eligibility criteria were defined as children and youth newly diagnosed with enthesis-related arthritis, polyarticular, or oligoarticular JIA between 2011 and 2019, with at least one year of observation. Data on c-DMARDs and b-DMARDs prescriptions were obtained from electronic medical charts. We used descriptive statistics, Kaplan–Meier survival methods, and Sankey diagrams to describe treatment prescription patterns. Results A total of 325 patients with JIA were included, with a median observation time of 3.7 years. The most frequently prescribed c-DMARD and b-DMARD were methotrexate and etanercept, respectively. Within the first year of rheumatology care, 62% and 21% of patients had a c-DMARD and a b-DMARD prescribed, respectively. These proportions varied greatly by JIA subtype. Among the 147 (147/325, 45%) patients that had at least one b-DMARD prescribed, 24% were prescribed a second, and 7% a third-line of b-DMARD. A total of 112 unique treatment sequences were observed, with c-DMARD monotherapy followed by the addition of either a b-DMARD (56%) or another c-DMARD (30%) being the two most prevalent patterns in this cohort. Conclusion We observed a variety of treatment trajectories, with many patients experiencing multiple treatment lines, illustrating the complexity of the overall JIA treatment path.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study

et al. 2022

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“…22,30,32,33 As clinicians have had more experience with etanercept compared with other biological agents, it is likely to be used by rheumatologists for first-line therapy when starting biological treatment, especially in oJIA and pJIA cases. 22,[32][33][34] In the BiKeR study, it was reported that etanercept was the most frequently prescribed first-line biological agent (79.9%), whereas it was rarely used after biological agent switching (4.1%). 33 In our study, similarly, we observed that, in the selection of biological agents, etanercept was the first choice, except for the sJIA patients.…”

Section: Discussionmentioning

confidence: 99%

“…In another single-center study that was carried out in Turkey, the reason for biological agent switching was unresponsiveness to the drug in all cases except for 1 case in which adverse effects developed. 34 Considering the diagnoses of the patients who required biological agent switching, sJIA patients were the majority in our study. This subtype was followed by RF− pJIA and persistent oJIA.…”

Section: Discussionmentioning

confidence: 99%

Biological Agent Switching in Patients With Juvenile Idiopathic Arthritis

et al. 2023

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ObjectiveThe purpose of this study is to investigate the causes and outcomes of switching biological agents in juvenile idiopathic arthritis (JIA) patients using biological agents and compare the characteristics of patients whose biological agents are switched and those whose are not.MethodsThis medical records review study was conducted with 128 patients who were diagnosed with JIA at our clinic between January 2009 and January 2022 and were receiving biologic agents. Factors affecting the biologic agent switching were investigated.ResultsThe JIA subtype with the most frequent switching in biological agents was systemic JIA (n = 13, 40.6%). Systemic JIA was followed by rheumatoid factor–negative polyarticular JIA and persistent oligoarticular JIA with 5 patients (15.6%), extended oligoarticular JIA and enthesitis-related JIA with 3 patients (9.3%), rheumatoid factor–positive polyarticular JIA with 2 patients (6.2%), and undifferentiated JIA with 1 patient (3.1%). Among the patients, 32 (25%) patients had their biological agent switched once, and 5 (3.9%) had theirs switched twice. The most frequently used biological agent was etanercept (n = 76, 59.3%), whereas the most frequently observed cases of biological agent switching were from an anti-TNF agent to another anti-TNF agent (40.6%). The reason for switching was unresponsiveness to the agent in 22 patients (68.8%), adverse effects in 6 patients (18.7%), drug intolerance in 1 patient (3.1%), and other reasons in 3 patients (9.3%).ConclusionsThe most frequently used biological agent was etanercept; the most frequent cases of biological agents switching were from an anti-TNF agent to another anti-TNF agent.

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Do the features of juvenile psoriatic arthritis change according to age? A comprehensive evaluation of the PeRA Research Group Registry

Karadağ,

Coskuner,

Demirkan

et al. 2023

Rheumatology

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Objectives To describe the clinical features and treatment outcomes of children with juvenile psoriatic arthritis (JPsA) and compare the distinct patterns of the disease between early-onset and late-onset age groups. Methods Patients with JPsA followed regularly for at least 6 months between 2010 and 2020 in seven paediatric rheumatology centres in Turkey were included in the study. The demographic features, clinical manifestations, treatment strategies and outcomes of the patients were evaluated retrospectively. Results A total of 87 (46 male/41 female) patients were included in the study. The mean age at diagnosis was 11.9 years (s.d. 4.5). Fifty-seven (65.5%) patients had psoriasis at the time of diagnosis and arthritis preceded psoriasis in 10 (11.5%) patients. Thirty (34.5%) patients had dactylitis, 28 (32.2%) had nail pitting, 36 (41.4%) had involvement of the small joints and 20 (23%) had enthesitis. Sacroiliitis was detected in 11 (12.6%) patients by MRI. ANA was positive in 35 (40.2%) patients. Twelve children (13.8%) were in the early-onset (<5 years) group. Uveitis and ANA positivity were more common in the early-onset group. Active joint counts and activity scores of our patients showed significant improvement at month 6 and at the last control compared with baseline. Conclusion About one-third of patients with JPsA do not have psoriasis at the time of diagnosis. In some patients, no skin lesion is seen during the course of the disease. Children with PsA seem to display two different phenotypes. Younger children have a female predominance, ANA positivity and uveitis, while older children have more axial involvement.

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Approach to switching biologics in juvenile idiopathic arthritis: a real-life experience

Cited by 4 publications

References 17 publications

Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study

Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study

Biological Agent Switching in Patients With Juvenile Idiopathic Arthritis

Do the features of juvenile psoriatic arthritis change according to age? A comprehensive evaluation of the PeRA Research Group Registry

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