Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study
Tóm tắt
Pharmacological treatment is a cornerstone of care for children with juvenile idiopathic arthritis (JIA). The objective of this study is to evaluate prescription patterns of conventional and biologic disease modifying anti-rheumatic drugs (c-DMARDs and b-DMARDs) for patients with JIA. We conducted a retrospective cohort study of children diagnosed with JIA at a rheumatology pediatric clinic. Eligibility criteria were defined as children and youth newly diagnosed with enthesis-related arthritis, polyarticular, or oligoarticular JIA between 2011 and 2019, with at least one year of observation. Data on c-DMARDs and b-DMARDs prescriptions were obtained from electronic medical charts. We used descriptive statistics, Kaplan–Meier survival methods, and Sankey diagrams to describe treatment prescription patterns. A total of 325 patients with JIA were included, with a median observation time of 3.7 years. The most frequently prescribed c-DMARD and b-DMARD were methotrexate and etanercept, respectively. Within the first year of rheumatology care, 62% and 21% of patients had a c-DMARD and a b-DMARD prescribed, respectively. These proportions varied greatly by JIA subtype. Among the 147 (147/325, 45%) patients that had at least one b-DMARD prescribed, 24% were prescribed a second, and 7% a third-line of b-DMARD. A total of 112 unique treatment sequences were observed, with c-DMARD monotherapy followed by the addition of either a b-DMARD (56%) or another c-DMARD (30%) being the two most prevalent patterns in this cohort. We observed a variety of treatment trajectories, with many patients experiencing multiple treatment lines, illustrating the complexity of the overall JIA treatment path.
Tài liệu tham khảo
Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet (London, England). 2011;377:2138–49.
Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet (London, England). 2007;369:767–78.
Shiff NJ, Lix LM, Oen K, Joseph L, Duffy C, Stringer E, et al. Chronic inflammatory arthritis prevalence estimates for children and adolescents in three Canadian provinces. Rheumatol Int. 2015;35:345–50.
Shepherd J, Cooper K, Harris P, Picot J, Rose M. The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation. Health Technol Assess (Winchester, England). 2016;20:1–222.
Glerup M, Rypdal V, Arnstad ED, Ekelund M, Peltoniemi S, Aalto K, et al. Long-term outcomes in juvenile idiopathic arthritis: eighteen years of follow-up in the population-based nordic juvenile idiopathic arthritis cohort. Arthritis Care Res (Hoboken). 2020;72:507–16.
Ungar WJ, Costa V, Burnett HF, Feldman BM, Laxer RM. The use of biologic response modifiers in polyarticular-course juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum. 2013;42:597–618.
Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American college of rheumatology/arthritis foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Rheumatol. 2019;71:846–63.
Kip MMA, de Roock S, Currie G, Marshall DA, Grazziotin LR, Twilt M, et al. Costs of medication use among patients with juvenile idiopathic arthritis in the Dutch healthcare system. Expert Rev Pharmacoecon Outcomes Res. 2021;21(5):975–84.
Kip MMA, de Roock S, van den Berg I, Currie G, Marshall DA, Grazziotin LR, et al. Costs of hospital-associated care for patients with juvenile idiopathic arthritis in the Dutch healthcare system. Arthritis Care Res (Hoboken). 2021. https://doi.org/10.1002/acr.24621. Epub ahead of print.
Kearsley-Fleet L, Heaf E, Davies R, Baildam E, Beresford MW, Foster HE, et al. Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study. Lancet Rheumatology. 2020;2:e217–26.
Karadağ ŞG, Demirkan FG, Koç R, Çakmak F, Sönmez HE, AktayAyaz N. Approach to switching biologics in juvenile idiopathic arthritis: a real-life experience. Rheumatol Int. 2021;42(1):141–7.
Shiff NJ, Oen K, Rabbani R, Lix LM. Validation of administrative case ascertainment algorithms for chronic childhood arthritis in Manitoba. Canada Rheumatol Int. 2017;37:1575–84.
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, edmonton, 2001. J Rheumatol. 2004;31:390–2.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Wickham H. ggplot2: Elegant Graphics for Data Analysis. New York: Springer-Verlag; 2016.
Wickham H, Averick M, Bryan J, Chang W, McGowan LDA, François R, et al. Welcome to the {tidyverse}. J Open Source Softw. 2019;4:1686.
Therneau TM. A Package for Survival Analysis in R. 2020. Available from: https://CRAN.R-project.org/package=survival.
Otten MH, Anink J, Prince FH, Twilt M, Vastert SJ, ten Cate R, et al. Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national arthritis and biologics in children register. Ann Rheum Dis. 2015;74:1379–86.
Davies R, Carrasco R, Foster HE, Baildam EM, Chieng SEA, Davidson JE, et al. Treatment prescribing patterns in patients with juvenile idiopathic arthritis (JIA): Analysis from the UK Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum. 2016;46:190–5.
Chhabra A, Oen K, Huber AM, Shiff NJ, Boire G, Benseler SM, et al. Real-world effectiveness of common treatment strategies for juvenile idiopathic arthritis: results from a canadian cohort. Arthritis Care Res (Hoboken). 2020;72:897–906.
Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, et al. 2011 American college of rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011;63:465–82.
Singh JA, Saag KG, Bridges SL, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American college of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68:1–26.
Batthish M, Berard R, Cabral D, Bolaria R, Chédeville G, Duffy C, et al. A new Canadian inception cohort for juvenile idiopathic arthritis: the canadian alliance of pediatric rheumatology investigators registry. Rheumatology (Oxford). 2020;59:2796–805.
Huang B, Qiu T, Chen C, Zhang Y, Seid M, Lovell D, et al. Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis. RMD Open. 2020;6(1):e001091.
Brunner HI, Schanberg LE, Kimura Y, Dennos A, Co DO, Colbert RA, et al. New medications are needed for children with juvenile idiopathic arthritis. Arthritis Rheumatol. 2020;72:1945–51.