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

for the Childhood Arthritis and Rheumatology Research Alliance Registry Investigators and the UK Juvenile Idiopathic Arthritis Biologics Register Investigators

Research output: Contribution to journalArticlepeer-review

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. (Figure presented.).

Original languageEnglish
Pages (from-to)1090-1098
Number of pages9
JournalArthritis Care and Research
Volume76
Issue number8
DOIs
StatePublished - Aug 2024

Funding

FundersFunder number
Childhood Arthritis and Rheumatology Research Alliance
UK Juvenile Idiopathic Arthritis Biologics Register
National Institutes of Health
U.S. Food and Drug Administration
Patient-Centered Outcomes Research Institute
University of Manchester
Manchester Biomedical Research CentreNIHR203308
Manchester Biomedical Research Centre
British Society for Rheumatology and Versus Arthritis20747
Centre for Epidemiology Versus Arthritis, University of Manchester21755
Centre for Epidemiology Versus Arthritis, University of Manchester

    Fingerprint

    Dive into the research topics of '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'. Together they form a unique fingerprint.

    Cite this