Persistence and adverse events of biological treatment in adult patients with juvenile idiopathic arthritis: results from BIOBADASER

Baute, Juan José Bethencourt; Sánchez-Piedra, Carlos; Ruiz-Montesinos, D.; Ildefonso, Marta Medrano San; Rodríguez‐Lozano, Carlos; Pérez‐Pampín, Eva; Ortiz, Ana M.; Manrique-Arija, Sara; Roselló, Rosa; Hernandez, V.; Campos, C.; Sellas‐Fernández, Agustí; Giraldo, Walter Alberto Sifuentes; García‐González, Javier; Sánchez‐Alonso, Fernando; Dı́az-González, Federico; Gómez-Reino, Juan J.; Reyes, Sagrario Bustabad

doi:10.1186/s13075-018-1728-3

Cited by 5 publications

(4 citation statements)

References 42 publications

(36 reference statements)

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“…Nevertheless, even in the subgroup of this cohort that had the disease onset after the year 2000, 41.6% started the bDMARD later than 5 years of disease onset. This is in line with other registries like Biker and Biobadaser, which showed that in 2000, only around 25% of patients received the first biologic at a pediatric age, with this percentage increasing linearly until reaching 65% in 2015 [8,26].…”

Section: Discussionsupporting

confidence: 91%

Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes

Oliveira Ramos,

Rodrigues,

Melo

et al. 2023

Arthritis Res Ther

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Background Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact of the time between JIA onset and the initiation of a bDMARD in achieving clinical remission, on physical disability and health-related quality of life (HRQoL). Methods Adult JIA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) and ever treated with bDMARD were included. Data regarding socio-demographic, JIA-related characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), and treatments were collected at the last visit. Patients were divided into 3 groups (≤ 2 years, 2–5 years, or > 5 years), according to the time from disease onset to bDMARD initiation. Regression models were obtained considering remission on/off medication, HAQ-DI, SF-36, and joint surgeries as outcomes and time from disease onset to bDMARD start as an independent variable. Results Three hundred sixty-one adult JIA patients were evaluated, with a median disease duration of 20.3 years (IQR 12.1; 30.2). 40.4% had active disease, 35.1% were in remission on medication, and 24.4% were in drug-free remission; 71% reported some degree of physical disability. Starting a bDMARD > 5 years after disease onset decreased the chance of achieving remission off medication (OR 0.24; 95% CI 0.06, 0.92; p = 0.038). Patients who started a bDMARD after 5 years of disease onset had a higher HAQ and worse scores in the physical component, vitality, and social function domains of SF-36, and more joint surgeries when compared to an earlier start. Conclusion Later initiation of bDMARDs in JIA is associated with a greater physical disability, worse HRQoL, and lower chance of drug-free remission in adulthood.

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Section: Discussionsupporting

confidence: 91%

Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes

Oliveira Ramos,

Rodrigues,

Melo

et al. 2023

Arthritis Res Ther

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“…Recent German pJIA therapy algorithms include tocilizumab in the first-line use of biological agents [9], as do the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Consensus Treatment Plans [8]. The pathways of using biological agents in clinical practice are constantly changing [10,20] and vary considerably in different countries due to local regulations and availability of the biological agents [11,12,[20][21][22]. Since there is rather short experience of tocilizumab in the treatment of pJIA, only few register and observational reports have been published on the safety and efficacy of tocilizumab so far [11,12,16].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tocilizumab in a real-life observational cohort of patients with polyarticular juvenile idiopathic arthritis

et al. 2019

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Objectives To evaluate the patterns of usage, efficacy and safety of tocilizumab in polyarticular JIA. Methods An observational study of 56 consecutive polyarticular JIA patients was conducted using patient charts and electronic JIA databases. Efficacy was assessed by tocilizumab survival, rates of low disease activity (LDA) and of inactive disease by 10-joint Juvenile Arthritis Disease Activity Score (JADAS-10), and of clinically inactive disease according to Wallace’s preliminary criteria. Efficacy and rate of adverse events (AEs) were evaluated during a 24-month period after tocilizumab commencement. Results Tocilizumab was started on average as third-line biological agent (median, range first- to fourth-line) at a median disease duration of 5.2 years (interquartile range 3.0–7.7). Survival rates were 82% at 12 months and 64% at 24 months. The reasons for discontinuation were inadequate treatment effect in 50%, AE plus inadequate treatment effect in 37.5% and AE alone in 12.5%. LDA (JADAS-10 ⩽3.9) was reached in 58% at 12 months and in 84% at 24 months, inactive disease (JADAS-10 ⩽0.7) in 19% and 44%, and clinically inactive disease in 28% and 46%, respectively. The rate of AEs was 200.9/100 patient years and of serious AEs 12.9/100 patient years. Conclusion Survival of tocilizumab was high and a large proportion of the treatment-resistant patients reached LDA at 12 months of treatment. The LDA rate continued to increase throughout 24 months. The rates of AEs and serious AEs were higher than in register studies but lower than in the originator study of tocilizumab.

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“…In contrast to the hopeful results of this retrospective study, data from the ABC registry revealed that despite the high rates of good response to etanercept in psoriatic JIA patients, 5/6 patients who ceased treatment at 22 months flared at a median of 2 months ( Otten et al, 2011b ). Finally, longer retention of the first biologic, as well as increased frequency of treatment suspension due to remission was observed in patients aged less than 16 years at the initiation of biologic therapy, as per data from a Spanish biologic registry ( Bethencourt Baute et al, 2018 ).…”

Section: Various Predictor Biomarkers For Successful Withdrawal Of Bimentioning

confidence: 88%

Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis

et al. 2021

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Background: Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis of childhood, characterized by various clinical phenotypes associated with variable prognosis. Significant progress has been achieved with the use of biologic treatments, which specifically block pro-inflammatory molecules involved in the disease pathogenesis. The most commonly used biologics in JIA are monoclonal antibodies and recombinant proteins targeting interleukins 1 (IL-1) and 6 (IL-6), and tumor necrosis factor α (TNF-α). Several biomarkers have been investigated in JIA.Aims: To assess the level of evidence available regarding the role of biomarkers in JIA related to guiding clinical and therapeutic decisions, providing disease prognostic information, facilitating disease activity monitoring and assessing biologic treatment response in JIA, as well as propose new strategies for biologic therapy-related biomarker use in JIA.Methods: We searched PubMed for relevant literature using predefined key words corresponding to several categories of biomarkers to assess their role in predicting and assessing biologic treatment response and clinical remission in JIA.Results: We reviewed serological, cellular, genetic, transcriptomic and imaging biomarkers, to identify candidates that are both well-established and widely used, as well as newly investigated in JIA on biologic therapy. We evaluated their role in management of JIA as well as identified the unmet needs for new biomarker discovery and better clinical applications.Conclusion: Although there are no ideal biomarkers in JIA, we identified serological biomarkers with potential clinical utility. We propose strategies of combining biomarkers of response to biologics in JIA, as well as routine implementation of clinically acceptable imaging biomarkers for improved disease assessment performance.

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Persistence and adverse events of biological treatment in adult patients with juvenile idiopathic arthritis: results from BIOBADASER

Cited by 5 publications

References 42 publications

Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes

Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes

Efficacy and safety of tocilizumab in a real-life observational cohort of patients with polyarticular juvenile idiopathic arthritis

Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis

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