Similar JIA outcomes with switch to second TNF inhibitor vs alternative biologic
medwireNews: Juvenile idiopathic arthritis (JIA) patients with an inadequate response to tumor necrosis factor (TNF) inhibitor therapy have similar outcomes regardless of whether they switch to a second agent from the same class or an alternative biologic, research suggests.
The analysis of the BCRD and BSPAR-ETN UK pediatric biologic registries, presented at the EULAR 2019 congress in Madrid, Spain, included 241 children and adolescents who switched from their first TNF inhibitor due to ineffectiveness, adverse events/intolerance, or personal preference. The majority (78%) of patients used etanercept as their first TNF inhibitor, followed by adalimumab (15%) and infliximab (7%).
Lianne Kearsley-Fleet (The University of Manchester, UK) told delegates that 81% of these patients switched to a second TNF inhibitor – either adalimumab (58%), infliximab (37%), or etanercept (6%) – while 19% switched to another biologic, including tocilizumab (73%), rituximab (13%), or abatacept (13%).
Six months after switching, average JADAS-71 scores were not significantly different among patients who switched to a second TNF inhibitor versus an alternative biologic (7.3 vs 8.5 points), and a comparable proportion of patients in both groups achieved minimal disease activity (30 vs 23%) or a 90% improvement in pediatric ACR criteria (22 vs 15%).
Kearsley-Fleet noted that 62% of the cohort remained on their second biologic agent 1 year after the switch, and there was no difference in treatment retention rates between the two groups. She said that the majority of patients who stopped taking their second biologic during this time did so due to ineffectiveness (48%) or adverse events (16%).
These findings suggest “no difference in effectiveness outcomes or drug survival in children and young people with JIA switching to a second TNF inhibitor compared with an alternative class of biologic after initial TNF inhibitor has failed,” said Kearsley-Fleet.
She noted that current UK guidelines “recommend that patients should switch to a second TNF inhibitor unless they are rheumatoid factor-positive, in which case they should start rituximab.”
And she concluded: “We don’t see any reason why the guidelines should be changed.”
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