Melissa L Mannion1, Fenglong Xie1, Daniel B Horton1, Sarah Ringold1, Colleen K Correll1, Anne Dennos1, Timothy Beukelman. 1. This project was supported by funding from the Childhood Arthritis and Rheumatology Research Alliance. M.L. Mannion, MD, MSPH, Assistant Professor, T. Beukelman, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; F. Xie, PhD, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; D.B. Horton, MD, MSCE, Assistant Professor, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey; S. Ringold, MD, MS, Assistant Professor, Division of Pediatric Rheumatology, Seattle Children's Hospital, Seattle, Washington; C.K. Correll, MD, MPH, Assistant Professor, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; 6A. Dennos, MSPH, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA. TB declares conflicts with Novartis and UCB. The remaining authors declare no conflicts of interest. Address corresponding author to Dr. M.L. Mannion,1600 7th Ave South, CPPN G10, Birmingham, AL 35233, USA. Email: mmannion@peds.uab.edu. Accepted for publication August 26, 2020.
Abstract
OBJECTIVE: Biologic medications have significantly improved disease control and outcomes of patients with juvenile idiopathic arthritis ( JIA). Current treatment recommendations suggest escalating therapy, including changing biologics if needed, when inactive or low disease activity is not attained. The patterns and reasons for switching biologics in clinical practice in North America are not well described. METHODS: We used the Childhood Arthritis and Rheumatology Research Alliance Registry and included individuals with JIA if they newly started a biologic after January 1, 2008, and had at least 12 months of subsequent observable time. Subjects with systemic JIA were excluded. We compared characteristics of switchers and nonswitchers using chi-square for categorical variables and Wilcoxon rank-sum test for continuous variables, and used linear regression for time analysis. RESULTS: Of the eligible children, 1361 with JIA in the registry started a biologic (94% tumor necrosis factor inhibitors [TNFi]). Median followup time was 30 months and 349 (26%) switched biologics. Among biologic switchers, ineffectiveness/disease flare was the most common reason for switch (202, 58%). The most common documented switch was from etanercept to another TNFi (221, 63%). The median time to switch to a second biologic decreased substantially from 55.2 months in 2008 to 7.2 months in 2016. CONCLUSION: In a multicenter cohort of patients with JIA starting a biologic, one-quarter switched to a second biologic, and the time to switching decreased in recent years. Additional studies should evaluate the outcomes and optimal timing of switching and preferred sequence of biologic use.
OBJECTIVE: Biologic medications have significantly improved disease control and outcomes of patients with juvenile idiopathic arthritis ( JIA). Current treatment recommendations suggest escalating therapy, including changing biologics if needed, when inactive or low disease activity is not attained. The patterns and reasons for switching biologics in clinical practice in North America are not well described. METHODS: We used the Childhood Arthritis and Rheumatology Research Alliance Registry and included individuals with JIA if they newly started a biologic after January 1, 2008, and had at least 12 months of subsequent observable time. Subjects with systemic JIA were excluded. We compared characteristics of switchers and nonswitchers using chi-square for categorical variables and Wilcoxon rank-sum test for continuous variables, and used linear regression for time analysis. RESULTS: Of the eligible children, 1361 with JIA in the registry started a biologic (94% tumor necrosis factor inhibitors [TNFi]). Median followup time was 30 months and 349 (26%) switched biologics. Among biologic switchers, ineffectiveness/disease flare was the most common reason for switch (202, 58%). The most common documented switch was from etanercept to another TNFi (221, 63%). The median time to switch to a second biologic decreased substantially from 55.2 months in 2008 to 7.2 months in 2016. CONCLUSION: In a multicenter cohort of patients with JIA starting a biologic, one-quarter switched to a second biologic, and the time to switching decreased in recent years. Additional studies should evaluate the outcomes and optimal timing of switching and preferred sequence of biologic use.