In adult patients with juvenile idiopathic arthritis (JIA), rates of biologic drug survival and suspension by remission were both higher in those who initiated biologic treatment at <16 years, according to findings published in Arthritis Research & Therapy. Although serious adverse events occurred at similar rates in both adult and pediatric biologic-treated patients, the incidence rates for infections were significantly higher in those <16 years.
There have been few studies examining the JIA population relating to biologic drug survival, discontinuation, and overall safety, particularly during the transition from childhood to adulthood. Investigators sought to address this knowledge gap in an observational study.
The Spanish Registry for Adverse Events of Biological Therapy in Rheumatic Diseases (BIOBADASER) is a prospective, multicenter tracking study of patients with rheumatic diseases receiving biologic therapies with a focus on long-term safety. Researchers considered all adults with a JIA diagnosis made between February 2000 and December 2015. Outcomes of interest included drug survival or discontinuation for any reason, and incidence rates per 1000 patient-years for adverse events.
The BIOBADASER review examined medical records of 469 patients (mean age, 34.5 years; 53.9% men; mean age at diagnosis, 9.4 years; mean age at biologic initiation, 23.9 years; mean biologic treatment duration, 9.6 years). Between 2000 and 2014, there was a linear increase in the rate of pediatric biologic use to treat JIA, rising from 24% to 65%.
When comparing biologic use in participants who were <16 years at initiation vs those ≥16 years, the most prescribed compounds were etanercept (59.1%) and infliximab (40.4%), respectively. The leading reasons for suspension of treatment in these groups were inefficacy (37.1% and 37.4%, respectively) and adverse event occurrence (28.6% and 28.0%, respectively). Discontinuation because of remission was significantly higher in those who had begun biologic therapy before age 16 vs those who started the medications at or after 16 years of age (25.7% vs 7.9%; P <.0001).
The total incidence rate for serious adverse events among all patients was 41.4 per 1000 patient-years and was similar when comparing participants <16 years (35.7 per 1000 patient-years) with those ≥16 years (43.2 per 1,000 patient-years). However, infections occurred significantly more often in the younger group compared with the older group (253.2 vs 136.0 per 1000 patient-years; P <.001).
Study strengths included the use of a registry that permitted safety analysis of a large sample of typical patients with JIA. Study limitations included the BIOBADASER study not being focused specifically on JIA, use of a different classification system than that normally used in this population, and a lack of individual drug comparisons.
“The prospective records of these adult patients with JIA treated with biologic therapy can contribute to improving knowledge about the behavior of this disease in adulthood,” the authors noted.
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Baute JJB, Sanchez-Piedra C, Ruiz-Montesinos D, et al. Persistence and adverse events of biological treatment in adult patients with juvenile idiopathic arthritis: results from BIOBADASER. Arthritis Res Ther. 2018;20(1):1-9.