Treatment prescribing patterns in patients with juvenile idiopathic arthritis (JIA): Analysis from the UK Childhood Arthritis Prospective Study (CAPS).

Rebecca Davies,Roberto Carrasco,Kimme L Hyrich,Eileen M Baildam,Joyce E Davidson,Lucy R Wedderburn,Helen E Foster,S.E Alice Chieng,Wendy Thomson,Yiannis Ioannou

doi:10.1016/j.semarthrit.2016.06.001

Abstract

ObjectiveInitial treatment of juvenile idiopathic arthritis (JIA) is largely based on the extent of joint involvement, disease severity and ILAR category. The licensing of biologic therapies for JIA has expanded treatment options.The aims of the study are (1) to describe treatment prescribing patterns in JIA over the first 3 years following first presentation to paediatric rheumatology and (2) to determine whether patterns of treatment have changed as biologics have become more widely available.MethodsChildren with at least 3 years of follow-up within the Childhood Arthritis Prospective Study (CAPS) were included.For analysis, children were placed into one of five groups according to their initial presentation to paediatric rheumatology: oligoarthritis (oJIA), polyarthritis (pJIA), systemic (sJIA), enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). Treatment patterns over 3 years were described.ResultsOf 1051 children, 58% received synthetic disease-modifying anti-rheumatic drugs (sDMARD) and 20% received biologics over the 3 years. Use of sDMARDs and biologics was higher in more severe disease presentations (sJIA and pJIA); however, 35% and 10% who presented with oJIA were also treated with sDMARDs and biologics, respectively. The number of children receiving sDMARD after 2006 was higher (p = 0.02); however, there was no difference in biologic prescribing before and after 2006 (p = 0.4).ConclusionsA high proportion of children presenting with JIA received sDMARDs plus/minus biologics during 3 years of follow-up. This was most common for patients with severe JIA but was also prescribed for patients with oligoarticular disease, despite the lack of evidence for effectiveness in this category.

Highlights

Juvenile idiopathic arthritis (JIA) is the most common chronic, inflammatory rheumatic disease among children with a UK prevalence rate of approximately 1 in 1000 [1]
58% received a synthetic disease-modifying anti-rheumatic drugs (sDMARDs) and 20% received a biologic within this 3-year period, none of whom were prescribed abatacept over the period of observation
35% of those initially presenting with oligoarthritis later went on to receive sDMARDs and 10% received a biologic

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is the most common chronic, inflammatory rheumatic disease among children with a UK prevalence rate of approximately 1 in 1000 [1]. Initial treatment is largely based on the extent of joint involvement, disease severity and category [3]. There remain a proportion of children who will not respond to these initial therapies and further interventions will be required [4]. Their category may evolve, such as an initial oligoarticular presentation developing into a polyarticular course, resulting in a stepup in therapy. The introduction of biological agents in the last 15 years has offered further treatment options to those with severe polyarticular or systemic disease who do not respond adequately to initial therapy. The evidenced based choice of biologics for JIA has expanded to include other anti-TNF therapies [e.g., adalimumab and infliximab (off-label use in Europe)] as well as alternative cytokine blockade for both systemic and polyarticular JIA (e.g., the IL-6 inhibitor tocilizumab and IL-1 blockade with anakinra) [9]

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