OBJECTIVES

Children with Juvenile idiopathic arthritis (JIA) are frequently treated with biologic disease-modifying antirheumatic drugs (DMARD). Poor persistence and adherence are serious issues in the management of chronic conditions. This study investigated treatment persistence with and response to biologic (b)DMARDs commenced in children with newly diagnosed non-systemic JIA.

METHODS

A retrospective cohort study was conducted to determine time to first- and second-course discontinuation (switching or discontinuing) of bDMARDs using a pediatric hospital’s electronic medical record (EMR) database between 2009 and 2018. Patients newly diagnosed with non-systemic forms of JIA who were prescribed bDMARDs are eligible for the study. The first biologic prescription date in EMRs was the index visit. Persistence was defined as the time duration from treatment initiation to discontinuation (gap in therapy of the same drug ≥90 days).First-course therapy was defined as first exposure to bDMARDs, and second-course therapy was defined as exposure to bDMARDs after first discontinuation. Kaplan–Meier analysis and Cox proportional hazards models were used to assess time to discontinuation and logistic regression was conducted to identify characteristics associated with persistence.

RESULTS

Of 504 patients meeting inclusion criteria, 97 (15%) children had used ≥3 bDMARDs. Mean persistent time of first-course and second-course therapy over 24 months was 678 (median 448) and 507 days (median 315), respectively. Most patients (90.8%) were prescribed anti-tumor necrosis factor (TNF) therapy as their first-course treatment. A significantly (p= 0.0249) higher proportion of children with etanercept as first-course therapy were persistent compared to children with adalimumab. In second-course therapy, 62 (22.7%) patients had failed and were exposed to non-approved bDMARDs (golimumab, infliximab, anakinra, ustekinumab, etc.). Discontinuations were similar among anti-TNF drugs, including adalimumab, etanercept, golimumab, and infliximab.

CONCLUSIONS

Patients with etanercept use were more persistent than patients with adalimumab in the first-course therapy. Second-course discontinuation was similar among anti-TNF therapies.