Abstract
BackgroundWe aimed to characterize etanercept (ETN) use in juvenile idiopathic arthritis (JIA) patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry.MethodsThe CARRA Registry is a convenience cohort of patients with paediatric onset rheumatic diseases, including JIA. JIA patients treated with ETN for whom the month and year of ETN initiation were available were included. Patterns of ETN and methotrexate (MTX) use were categorized as follows: combination therapy (ETN and MTX started concurrently), step-up therapy (MTX started first and ETN added later), switchers (MTX started and then stopped when or before ETN started), MTX add-on (ETN started first and MTX added later), and ETN only (no MTX use). Data were described using parametric and non-parametric statistics as appropriate.ResultsTwo thousand thirty-two of the five thousand six hundred forty-one patients with JIA met inclusion criteria (74% female, median age at diagnosis 6.0 years [interquartile range 2.0, 11.0]. Most patients (66.9%) were treated with a non-biologic disease modifying anti-rheumatic drug (DMARD), primarily MTX, prior to ETN. There was significant variability in patterns of MTX use prior to starting ETN. Step-up therapy was the most common approach. Only 34.0% of persistent oligoarticular JIA patients continued treatment with a non-biologic DMARD 3 months or more after ETN initiation. ETN persistence overall was 66.3, 49.4, and 37.3% at 24, 36 and 48 months respectively. ETN persistence among spondyloarthritis patients (enthesitis related arthritis and psoriatic JIA) varied by MTX initiation pattern, with higher ETN persistence rates in those who initiated combination therapy (68.9%) and switchers/ETN only (73.3%) patients compared to step-up (65.4%) and MTX add-on (51.1%) therapy.ConclusionThis study characterizes contemporary patterns of ETN use in the CARRA Registry. Treatment was largely in keeping with American College of Rheumatology guidelines.
Highlights
We aimed to characterize etanercept (ETN) use in juvenile idiopathic arthritis (JIA) patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry
This study describes ETN use and patterns of concurrent MTX therapy in patients with JIA enrolled in the CARRA Registry
The CARRA Registry is approved by the Duke University IRB (Pro00054616), Patient population In order to gain a broad understanding of factors leading to ETN initiation for JIA and the interplay between methotrexate and ETN in real-world settings, all JIA patients in the CARRA Registry ever treated with ETN were included, except for patients with a concurrent diagnosis of a secondary rheumatologic condition or inflammatory bowel disease prior to ETN initiation
Summary
We aimed to characterize etanercept (ETN) use in juvenile idiopathic arthritis (JIA) patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease with prevalence rates between 0.038 and 4 per 1000 [1], and encompasses 7 categories of inflammatory arthritis [2]. In 1999, etanercept (ETN) became the first anti-tumor necrosis factor (anti-TNF) therapy approved by the Food and Drug Administration (FDA) for polyarticular JIA, and has since been shown to be effective in multiple categories of JIA (reviewed in [3,4,5,6,7,8]). The American College of Rheumatology (ACR) includes antiTNF therapy in its JIA treatment guidelines [9, 10]. ETN is often prescribed in combination therapy with methotrexate (MTX), but the frequency and patterns of combination therapy have not been well characterized
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