Background Only few biologics are approved for treatment of juvenile idiopathic arthritis (JIA) while numerous drugs were used additionally on an off label use.
Objectives To ananlyse the primary and the sequential use of biologics in JIA patients.
Methods Analysis of the courses and reasons for discontinuation of biologics treatment in the German BIKER registry.
Results A total of 2566 treatment courses with biologics have been documented in 2016 JIA patients. 1583 patients received one biologic, 337 two, 77 three, 18 four and 1 patient received 6 different biologic agents. Thus 21.5% only switched from one to at least a second biologic. As expected, etanercept is the most commonly used agent (n=1778), followed by adalimumab (463), tocilizumab (81), anakinra (61), abatacept (57), infliximab (48), golimumab (28), and canakinumab (14). Thus, etanercept is the most commonly used biologic and 60% of patients treated with adalimumab have first tried etanercept. The kind and number of first line biologic, ever used biologic and last biologic agent used is given in Table 1. Of interest, these numbers differ markedly in JIA patients with systemic arthritis and in JIA patients with uveitis history.
Adherence (ratio of last to ever used biologic) in all JIA patients was highest in tocilizumab (95%) followed by etanercept (79%), adalimumab (79%), abatacept (68%), anakinra (64%) and canakinumab (50%). In systemic JIA adherence was higher in tocilizumab (90%) than with anakinra (67%), canakinumab (62%) followed by with TNF-inhibitors (50%> 62%) and lowest for abatacept (25%).
Inefficacy was the most common reason for discontinuation of biologics (13%) followed by remission (11.3%) and intolerance (4.8%). Thus only few patients did not tolerate treatment with biologics. Inefficacy led to discontinuation of abatacept in 12(21.1%), etanercept in 283 (15.6%), canakinumab in 2 (14%), adalimumab in 31 (6.7%), tocilizumab in 3 (4%), infliximab in 1 and golimumab in 2 (4%).
Conclusions JIA patients are exposed to a number of different biologics. The majority of patients were still exposed to a single biologic. Inefficacy is the most common reason for discontinuation while intolerance is infrequent. The use of anakina, canakinumab and tocilizumab is more frequent in systemic JIA patients, TNF inhibitors were still used in the majority of patients. Since participation on the registry is voluntary, off label use might be underestimated.
Disclosure of Interest G. Horneff Grant/research support from: Pfizer, Abbott, Roche, K. Minden Grant/research support from: Pfizer, Abbott, H. Huppertz: None Declared
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