Use of biologic drugs in juvenile idiopathic arthritis patients followed in an adult rheumatology clinic: real-life data from the HUR-BIO biologic registry

TL;DR

This study examines biologic drug use and outcomes in adult patients with juvenile idiopathic arthritis, finding that certain subgroups experience higher disease severity and treatment changes.

Contribution

The study provides real-life data on biologic treatment patterns and outcomes in JIA patients transitioning to adult care, highlighting subgroup differences.

Findings

Enthesitis-related arthritis and polyarthritis are the most common JIA subgroups in adult clinics.

Secondary failure is the main reason for changing biologic treatments during follow-up.

Polyarticular JIA is associated with higher disease severity and disability compared to other subgroups.

Abstract

This study aimed to determine whether there are differences in biologic treatment and complications according to subgroups of juvenile idiopathic arthritis (JIA) patients in adulthood.

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) has been a single-center biologic disease-modifying anti-rheumatic drug registry since 2005. Patients were selected from HUR-BIO who met the International League of Associations for Rheumatology classification criteria for juvenile idiopathic arthritis.

Enthesitis-related arthritis (82, 49.1%), rheumatoid factor (-) polyarthritis (39, 23.4%), and rheumatoid factor ( +) polyarthritis (26, 15.6%) were the most prevalent subgroups in 167 JIA patients. Etanercept (105, 62.9%), adalimumab (28, 16.8%), and infliximab (21, 12.6%) were the most prescribed first-line biologic drugs. Secondary failure was the most common reason for the treatment changes among 42 (43.3%) patients, followed by non-life-threatening side effects in 12 (12.4%) and primary failure in 11 (11.3%). Polyarticular JIA showed higher HAQ (p = 0.020) and DAS28-ESR (p < 0.001) before biologics and had a longer disease duration to initiation of biologic treatment than enthesitis-related arthritis (p < 0.001). Only one patient (1.2%) in the enthesitis-related arthritis group needed the hip prosthesis, while 12 patients (18.5%) in the polyarticular JIA group required the same procedure (p < 0.001).

In adult rheumatology departments, the most common JIAs present with ongoing disease are enthesitis-related arthritis and polyarthritis. Secondary failure was the main reason nearly half of the patients needed biologic changes during follow-up. The polyarticular group appears to have a higher disease severity and level of disability.
Key Points• The most of juvenile idiopathic arthritis patients in adult rheumatology clinics require biologics are enthesitis-related arthritis and polyarticular arthritis.• Approximately half of the patients require biologic changes during follow-up, most of these due to secondary failure.• Disease severity and disability appear to be higher in the polyarticular group, therefore treatment intensification may be considered.

Key Points

• The most of juvenile idiopathic arthritis patients in adult rheumatology clinics require biologics are enthesitis-related arthritis and polyarticular arthritis.

• Approximately half of the patients require biologic changes during follow-up, most of these due to secondary failure.

• Disease severity and disability appear to be higher in the polyarticular group, therefore treatment intensification may be considered.

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