Department of Pediatric Rheumatology, University of Health Sciences, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey.
Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul University Medical School, Fatih, Istanbul, Turkey.
Rheumatol Int. 2022 Jan;42(1):141-147. doi: 10.1007/s00296-021-04854-y. Epub 2021 Apr 12.
The primary aim of the treatment of juvenile idiopathic arthritis (JIA) is complete remission and minimizing the development of complications. Though biologic agents (BAs) provide better disease control, data related to BA switching patterns in JIA patients are scarce. This study aimed to determine the BA switching patterns in JIA patients. The study included children with JIA that received ≥ 1 BAs. Disease activity was evaluated based on the juvenile arthritis disease activity score 71 (JADAS71). Demographic data, clinical and laboratory findings, BA switching patterns, and the rationales for BA switching were recorded. The study included 177 (82 female and 95 male) JIA patients that received ≥ 1 BAs. Mean age at diagnosis of JIA was 9.1 ± 4.9 years. BAs were prescribed a median of 14 months (range: 3-66 months) after diagnosis. Among the 177 patients, 31 (17.5%) required BA switching a median 10.5 months (range: 3-38 months) after initiation of the first BA. Among all the BAs that were switched to after administration of the first BA, tocilizumab was the most commonly switched (n = 15). The most common reason for BA switching was inadequate response (n = 29). BAs were switched 2 times in 5 patients and 3 times in 1 patient. When patients that switched BAs 1 time were compared to those that switched 2 and 3 times there were not any differences in terms of JIA types, whereas those that switched 2 and 3 times had a higher active joint count and JADAS71 score after 6 months of initiation of the first BA. As some of the JIA patients could not achieve remission despite using the prescribed BA, BA switching was required. Herein, we provide data on both BA switching patterns and requirements, which may improve the management of JIA patients.
治疗幼年特发性关节炎（JIA）的主要目标是完全缓解和最大限度地减少并发症的发生。虽然生物制剂（BAs）能更好地控制疾病，但关于 JIA 患者 BA 转换模式的数据却很少。本研究旨在确定 JIA 患者的 BA 转换模式。研究纳入了接受≥1 种 BA 的 JIA 患儿。疾病活动度根据幼年关节炎疾病活动评分 71 分（JADAS71）进行评估。记录了人口统计学数据、临床和实验室检查结果、BA 转换模式以及 BA 转换的理由。该研究纳入了 177 名（82 名女性和 95 名男性）接受≥1 种 BA 的 JIA 患者。JIA 诊断时的平均年龄为 9.1±4.9 岁。BA 在诊断后中位数 14 个月（范围：3-66 个月）开始使用。在 177 名患者中，有 31 名（17.5%）在首次使用 BA 后中位数 10.5 个月（范围：3-38 个月）需要 BA 转换。在所有转换后的 BA 中，托珠单抗是最常转换的（n=15）。BA 转换的最常见原因是反应不足（n=29）。有 5 名患者转换了 2 次 BA，1 名患者转换了 3 次 BA。在比较首次使用 BA 后转换 1 次的患者和转换 2 次和 3 次的患者时，JIA 类型方面没有差异，而转换 2 次和 3 次的患者在首次使用 BA 后 6 个月时的活跃关节计数和 JADAS71 评分更高。由于一些 JIA 患者即使使用了规定的 BA 也无法达到缓解，因此需要 BA 转换。在此，我们提供了 BA 转换模式和需求的数据，这可能有助于改善 JIA 患者的管理。
