Background Juvenile idiopathic arthritis (JIA) is a chronic arthritis with an onset before 16 years of age, that persists for at least 6 weeks, and has an unknown etiology.¹ Uveitis is a serious and common extra-articular manifestation of JIA, affecting 12–30% of patients (most commonly female with ANA+ oligoarthritis JIA category).^2,3 JIA-associated uveitis can be treated with biologic disease modifying antirheumatic drugs (bDMARDs), including TNF inhibitors (TNFi) such as etanercept (ETN), infliximab (IFX), and adalimumab (ADA), after failure of first-line treatments, such as topical corticosteroids and/or conventional synthetic DMARDs (csDMARDs), such as methotrexate (MTX).² Of note, reports exist that ETN use has been associated with uveitis flares or new-onset uveitis while an observational study reported similar uveitis flare rates for both ADA and ETN.^4,5

Objectives To conduct an analysis on the occurrence of uveitis in patients with JIA treated with ETN, ADA, or MTX. Combination therapy of ETN, ADA, and MTX was also assessed.

Methods International Statistical Classification of Diseases (ICD)-9 diagnosis codes in a Truven MarketScan® claims database were used to identify JIA patients diagnosed with uveitis over a 5-year interval. The analysis assessed the proportion of JIA patients (aged 0–19 years) treated with ETN, ADA, or MTX, as monotherapy or in combination. The percentage of patients diagnosed with uveitis and the time interval for uveitis diagnosis in patients with JIA was determined.

Results A total of 22,789 patients with JIA where included in this analysis and exhibited a mean age of 11.4 years, were predominantly female (69%), and mean JIA disease duration was 3 years. This total included 19,814 patients with chronic, or not otherwise specified, polyarticular JIA. A total of 2581 (11.3%) patients, of mean age 10.2 years, of which 73% were female, were diagnosed with uveitis. The numbers of JIA patients receiving biologic and/or MTX therapy and proportions with a uveitis diagnoses are shown in the Figure.

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Figure 1.

To show the patients with JIA receiving a monotherapy (with ETN, ADA or MTX) or a combination therapy and the number of uveitis diagnoses.

Conclusions This analysis showed a similar occurrence of uveitis in JIA patients treated with ETN or ADA, either as monotherapy or in combination with MTX.

References

1. Petty RE, et al. J Rheumatol 2004;31:390–2.

2. Clarke SL, et al. Pediatr Rheumatol Online J 2016;14:27.

3. Wentworth BA, et al. F1000Prime Rep 2014;6:41.

4. Schmeling H, Horneff G. Rheumatology (Oxford) 2005;44:1008–11.

5. Foeldvari I, et al. Arthritis Care Res 2015;67:1529–35.

References

Disclosure of Interest K. Roshak: None declared, J. M. Sopczynski Shareholder of: Pfizer, Employee of: Pfizer, R. M. Suehiro Shareholder of: Pfizer, Employee of: Pfizer, L. Marshall Shareholder of: Pfizer, Employee of: Pfizer