Objectives To analyze the efficacy and safety of biologic agent in adult patients with juvenile idiopathic arthritis (JIA).
Methods ATTRA is a Czech national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analysed adult JIA patients, who switched from TNF antagonists to another biologic treatment. Patients were treated in recommended doses for RA and the first drug was either infliximab (56.5%), or etanercept (23.6%), or adalimumab (19.9%). Those patients, who failed to improve in DAS28 by at least 1.2 after 3 months at 2 consecutive visits, who lost the response during the treatment, or who had to be discontinued due to adverse event, were switched to alternative anti-TNF or other biologic drug. Survival on therapy after 1st and 2nd biologic agents was calculated. Clinical efficacy was assessed with DAS28.
Safety assessments were done for all patients during the whole follow-up period. No guidelines have been issued for preference of the 1st or 2nd drug type and this was left purely to treating physician decision and was based on the assessment of overall clinical situation.
Results One hundred and sixty one adult JIA patients were treated with anti-TNF agents. Mean age of patients was 24.3 years, duration of disease was 14.3 years and 64% were women. Seventy seven (47.8%) patients received more than one biologic agent. DAS28 showed excellent and persistent improvement for those patients, who remained on the first drug. Response to second biologic agents was also significant, although with smaller differences to baseline DAS28. DAS28 at week 0 was 5.94±1.39 and decreased significantly to 2.77±1.44 at week 54 and 2.24±1.52 at week 108: Response to second anti-TNF was also significant, although with smaller differences to baseline DAS28; weeks 0, 54 and 108 were 5.84±1.36, 2.92±1.38, and 2.83±1.07, respectively.
Survival on the treatment was not statistically different in the first users in comparison with switched patients (p = 0.656); somewhat lower adherence to therapy was seen with the second agent (in first users and in switched patients, respectively: 1st year - 0.91 (95% CI: 0.86-0.95) and 0.88 (95% CI: 0.78-0.93); second year - 0.84 (95% CI: 0.77-0.89) and 0.71 (95% CI: 0.58-0.81).
Adverse events that lead to treatment discontinuation were observed during 1st and 2nd year of treatment with the first biologic drug in 6% and 8% and in 7% and 13% with the second agent. Treatment discontinuation due to inefficacy was observed with the 1st drug in 2% and 5 %, and in 3% and 9% with the 2nd agent during treatment years 1 and 2.
Conclusions biologic treatment in adult patients with juvenile idiopathic is effective and safe. Similarly to patients with RA, it is possible to regain efficacy after switching to second biologic drug in a majority of patients, although with somewhat lower difference between entry and 2 years DA28 evaluation. Good adherence to therapy was observed for both first and second biologic agents.
Acknowledgements Supported by Research Project from Ministry of Health in the Czech Republic No: 000 000 23728
Disclosure of Interest None Declared