TP2 INITIAL PRESCRIBING PATTERNS TRENDS IN NEWLY DIAGNOSED CHILDREN WITH NON-SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS IN US: ANALYSIS OF ELECTRONIC MEDICAL RECORDS FROM 2009 TO 2018

Abstract

The study describes patterns of initial medication prescriptions among children newly diagnosed with non-systemic forms of juvenile idiopathic arthritis (JIA), and its association with the disease activity outcomes from 2009- 2018. Using a pediatric hospital’s electronic medical record (EMR) between 2009 to 2018, we identified all patients with newly diagnosed JIA. Five subtypes of JIA were considered: oligoarticular JIA, polyarticular JIA, juvenile psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis. We examined patient baseline characteristics and initial prescribing patterns. The disease outcomes of initial prescribing patterns were described. A total of 821 patients were included in the analysis. Most patients were female (66.3%) and white race (88.9%). The median age was 11 years (IQR: 5–14). The proportion of patients who had an initial disease-modifying antirheumatic drugs (DMARD) prescription increased substantially from 2009 to 2018. The most common initial prescriptions were conventional synthetic (cs)DMARD and non-steroidal anti-inflammatory drugs (NSAIDs). For patients who were prescribed DMARD as initial therapy, csDMARDs monotherapy (57.3%) was most frequently used, followed by biologic agents and csDMARDs combination therapy (28.3%), and biologic (b)DMARDs monotherapy (14.4%). Methotrexate was the most commonly prescribed csDMARD throughout the study period, comprising more than 90% of monotherapy or combination therapy. Etanercept (56.3%) was the most prescribed bDMARDs, followed by adalimumab (36.6%). Nearly half (43.3%) of polyarticular JIA patients received a bDMARD prescription as initial therapy. The proportion of intra-articular glucocorticoid users increased considerably from 1.1% in 2009 to 25.6% in 2018. csDMARDs and NSAIDs appear to be the mainstay of first-line treatment initiated among non-systemic JIA patients over the past decade. However, biologic DMARDs are increasing in use, especially for treating children with polyarticular JIA.