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Effectiveness and safety of a second and third biological agent after failing etanercept in juvenile idiopathic arthritis: results from the Dutch National ABC Register
Annals of Rheumatic Diseases, 07/17/2012
Clinical Article
Otten MH et al. – Switching to another biological agent is common, especially for systemic juvenile idiopathic arthritis (JIA) patients. A second (and third) agent was less effective than the first. The choice of second biological agent by the physician mainly depends on availability and JIA category.
Methods- The Arthritis and Biologicals in Children Register aims to include all Dutch JIA patients who have used biological agents.
- Data on the disease course were used to estimate drug survival with Kaplan–Meier and calculate adverse event (AE) rates.
- Of 307 biologically naive JIA patients who started etanercept, 80 (26%) switched to a second and 22 (7%) to a third biological agent.
- During 1030 patient–years of follow–up after the introduction of etanercept, 49 switches to adalimumab, 28 infliximab, 17 anakinra, four abatacept and four trial drugs were evaluated.
- 84% (95% CI 80% to 88%) of patients who started etanercept as a first biological agent were, after 12 months, still on the drug, compared with 47% (95% CI 35% to 60%) who started a second and 51% (95% CI 26% to 76%) who started a third biological agent.
- Patients who switched because of primary ineffectiveness continued the second agent less often (32%, 95% CI 12% to 53%).
- After etanercept failure, drug continuation of adalimumab was similar to infliximab for patients with non–systemic JIA; anakinra was superior to a second TNF–blocker for systemic JIA.
- AE rates within first 12 months after initiation were comparable for each course and each biological agent.