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Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register
  1. Marieke H Otten1,
  2. Janneke Anink1,
  3. Femke H M Prince1,
  4. Marinka Twilt1,
  5. S J Vastert2,
  6. Rebecca ten Cate3,
  7. Esther P A H Hoppenreijs4,
  8. Wineke Armbrust5,
  9. Simone L Gorter6,
  10. Philomine A van Pelt1,
  11. Sylvia S M Kamphuis1,
  12. Koert M Dolman7,
  13. Joost F Swart2,
  14. J Merlijn van den Berg8,
  15. Yvonne Koopman-Keemink9,
  16. Marion A J van Rossum10,
  17. Nico M Wulffraat2,
  18. Lisette W A van Suijlekom-Smit1
  1. 1Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2Department of Pediatrics/Pediatric Rheumatology, Utrecht MC Wilhelmina Children's Hospital, Utrecht, The Netherlands
  3. 3Department of Pediatrics/Pediatric Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4Department of Pediatrics/Pediatric Rheumatology, St Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  5. 5Department of Pediatrics/Pediatric Rheumatology, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
  6. 6Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  7. 7Department of Pediatrics/Pediatric Rheumatology, St Lucas Andreas Hospital and Reade Institute, Amsterdam, The Netherlands
  8. 8Department of Pediatrics/Pediatric Rheumatology, Emma Children's Hospital, Amsterdam, The Netherlands
  9. 9Department of Paediatrics, Hagaziekenhuis Juliana Children's Hospital, The Hague, The Netherlands
  10. 10Department of Pediatrics/ Pediatric Rheumatology, Emma Children's Hospital/Academic Medical Centre and Reade Institute, Amsterdam, The Netherlands
  1. Correspondence to Dr Janneke Anink, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Na 1723, PO Box 2060, Rotterdam 3000 CB, The Netherlands; j.anink{at}


Background Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.

Objective To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA.

Methods The Arthritis and Biologics in Children register (multicentre prospective observational study) aimed to include all consecutive patients with JIA in the Netherlands who had started biological agents since 1999. Patients were divided according to year of introduction of first biological agent. Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years.

Results 335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010. Etanercept remained the most often prescribed biological agent for non-systemic JIA; anakinra became first choice for systemic JIA. The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased. During these 12 years of observation, biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS (Juvenile Arthritis Disease Activity Score) disease activity. All baseline disease activity parameters were lowered in patients with non-systemic JIA. In systemic JIA, prescription patterns changed towards very early introduction of biological agents (median 0.4 years of disease duration) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates. These changes for both systemic and non-systemic JIA resulted in more patients with inactive disease after 3 and 15 months of treatment.

Conclusions Biological agents are increasingly prescribed, earlier in the disease and in patients with JIA with lower disease activity. These changes are accompanied by better short-term disease outcomes.

  • Anti-TNF
  • DMARDs (biologic)
  • Epidemiology
  • Juvenile Idiopathic Arthritis
  • Outcomes Research

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