Comparative Effectiveness of a Second Tumor Necrosis Factor Inhibitor Versus a Non–Tumor Necrosis Factor Biologic in the Treatment of Patients With Polyarticular‐Course Juvenile Idiopathic Arthritis
Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: The objective of this study was to compare the effectiveness of a second tumor necrosis factor inhibitor (TNFi) versus a non-TNFi biologic following discontinuation of a TNFi for patients with polyarticular-course juvenile idiopathic arthritis (pJIA). METHODS: Using the Childhood Arthritis and Rheumatology Research Alliance Registry, patients with pJIA who started receiving a second biologic following a first TNFi were identified. Patients were required to have no active uveitis on the index date and a visit six months after the index date. Outcome measures included Clinical Juvenile Arthritis Disease Activity Score with a maximum of 10 active joints (cJADAS10), cJADAS10 inactive disease (ID; ≤2.5) and cJADAS10 minimal disease activity (MiDA; ≤5). Multiple imputation was used to account for missing data. Adjusted odds ratios (aORs) were calculated using propensity score quintiles to compare outcomes at six months following second biologic initiation. RESULTS: There were 216 patients included, 84% initially received etanercept, and most patients stopped receiving it because of its ineffectiveness (74%). A total of 183 (85%) started receiving a second TNFi, and 33 (15%) started receiving a non-TNFi. Adalimumab was the most common second biologic received (71% overall, 84% of second TNFi), and tocilizumab was the most common non-TNFi second biologic received (9% overall, 58% of non-TNFi). There was no difference between receiving TNFi versus non-TNFi in cJADAS10 ID (29% vs 25%; aOR 1.23, 95% confidence interval [CI] 0.47-3.20) or at least MiDA (43% vs 39%; aOR 1.11, 95% CI 0.47-2.62) at six months. CONCLUSION: Most patients with pJIA started receiving TNFi rather than non-TNFi as their second biologic, and there were no differences in disease activity at six months.
Source: Arthritis Care & Research
DOI: 10.1002/acr.25339
Institutions: University of Alabama at Birmingham, Childhood Arthritis and Rheumatology Research Alliance, Duke University, Duke Clinical Research Institute, Boston Children's Hospital, University of Minnesota, University of Manchester, Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,640
Funders: Patient-Centered Outcomes Research Institute, Rheumatology Research Foundation, Purdue University, Purdue Pharma, Childhood Arthritis and Rheumatology Research Alliance, National Institute for Health and Care Research, Department of Health and Social Care, British Society for Rheumatology, University of Manchester, Versus Arthritis, National Institutes of Health, U.S. Food and Drug Administration, Manchester Biomedical Research Centre, National Institute of Arthritis and Musculoskeletal and Skin Diseases
Awards: G1483213741, G1612446978, G1798610363, Investigating the safety and effectiveness of biologic treatments in children with rheumatic disease, Optimal Dosing for Biologic Agents in Obese Patients with Rheumatoid and Juvenile Arthritis, G5569198602, Centre for Epidemiology Arthritis UK, Developing a tool to support shared decision making in JIA between adolescents, parents, and providers
OpenAlex ID: W4393390008