Reduction in Methotrexate, Prednisone Use May Be Associated With Increased Safety, Tolerability in JIA

Researchers evaluated Canadian claims level data to assess the utilization of methotrexate and prednisone in patients with JIA who initiated etanercept therapy.

Etanercept use may be associated with a reduction or discontinuation of treatment with methotrexate or prednisone, resulting in benefits related to safety and tolerability in patients with juvenile idiopathic arthritis (JIA), according to study results published in Pediatric Rheumatology.

Using claims level data, researchers evaluated the use of methotrexate or prednisone in a cohort of Canadian pediatric patients (aged <18 years) with JIA who initiated therapy with etanercept. Longitudinal data were indexed on filling out an etanercept prescription between January 2008 and January 2016, and methotrexate and prednisone treatment were tracked from 6 months before and 12 months after the index date.

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Claims data for 330 biologic-naive patients were included in the analysis; 67% were girls, and 64% were aged between 10 and 17 years. A total of 316 patients completed 12 months of continuous etanercept therapy. Mean weekly initiation dose was 35 mg; this dose remained relatively consistent, and the weekly dose was higher in the oldest patients (aged 15-17 years) compared with the youngest patients (aged 1-4 years; 41 mg vs 14 mg, respectively) in the cohort.

Among the patients who initiated etanercept therapy, 67% (n=222) did not use methotrexate and 68% (223) did not use prednisone, either before or after etanercept initiation. Of the methotrexate- and prednisone-treated patients, 17% and 50%, respectively, discontinued those medications at etanercept initiation. The remaining methotrexate- and prednisone-treated patients continued either therapy within the first 12 months, although dosages were significantly decreased (for methotrexate: 14.3 mg/week to 6.8 mg/week; for prednisone: 56 mg/week to 23 mg/week).

“To the best of our knowledge, this is the first large study specifically designed to evaluate the potential steroid- and [methotrexate]-sparing effect of [etanercept] in pediatric patients in real-world practice,” the researchers noted.

Owing to the retrospective nature of the study, study limitations included the restricted availability of information regarding disease activity and severity, comorbid conditions, and other potentially relevant clinical or socioeconomic characteristics.

“Reductions in the use of concomitant medications may be beneficial in terms of safety, tolerability, and overall healthcare costs,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Khraishi M, Milson B, Woolcott J, Jones H, Marshall L, Ruperto N. Reduction in the utilization of prednisone or methotrexate in Canadian claims data following initiation of etanercept in pediatric patients with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2019;17:64.