OBJECTIVES

: To evaluate the persistence and effectiveness of tumor necrosis factor inhibitors (TNFi) vs. non-TNFi among newly diagnosed JIA patients after initiation of biologic disease-modifying anti-rheumatic drug (bDMARD).

METHODS

: Using longitudinal patient-level data extracted from electronic medical records (EMR) in a large Midwestern pediatric hospital from 2009-2018, we identified JIA patients initiating TNFi and non-TNFi. Treatment effectiveness was assessed based on disease activity. Inverse probability of treatment weighting (IPTW) of propensity score was used to estimate the treatment effectiveness and Kaplan–Meier analysis were conducted to assess persistence.

RESULTS

: Of 667 JIA patients, most (92.0%) were prescribed one of the class of TNFi as their initial biologic treatment. Etanercept was the most frequently prescribed (67.1%) treatment, followed by adalimumab (27.5%). Only around 5% of patients were prescribed off-label bDMARDs as their first-course treatment; however, more than 20% were prescribed off-label biologics as their second-course therapy. 7.3% of patients received four or more bDMARDs. The median persistence of the first-course bDMARD is 320 days, with TNFi being significantly longer than the non-TNFi (395 vs. 320 days, p =0.010). The cJADAS reduction was significant greater of TNFi users (6.6, 95% CI 5.7 to 7.5) compare to non-TNFi users (3.0, 95% CI 1.5 to 4.6, P<0.0001) at 6-month follow-up visit.

CONCLUSIONS

: Persistence was significantly longer among patients initiating TNFi as their first biologic therapy than those receiving non-TNFi. Patients with TNF therapy had significant greater reduction of cJADAS at the 6-month follow-up visit compared with patient in non-TNF cohort.