TY - JOUR
T1 - Real-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis
T2 - an observational study
AU - Grazziotin, Luiza R.
AU - Currie, Gillian
AU - Twilt, Marinka
AU - Ijzerman, Maarten J.
AU - Kip, Michelle M.A.
AU - Koffijberg, Hendrik
AU - Benseler, Susanne M.
AU - Swart, Joost F.
AU - Vastert, Sebastiaan J.
AU - Wulffraat, Nico M.
AU - Yeung, Rae S.M.
AU - Marshall, Deborah A.
N1 - Funding Information:
DAM is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008–2018). SB is supported by the Husky Energy Chair in Child and Maternal Health and the Alberta Children’s Hospital Foundation Chair in Pediatric Research. RSMY is supported by the Hak-Ming and Deborah Chiu Chair in Paediatric Translational Research. LRG is supported by Alberta Innovates Graduate Studentship and Arthritis Society (TGP-18–0244).
Funding Information:
We would like to acknowledge the contributions of Carolina de La Rosa, Damilola Omotajo, and Sarah Cooper as reviewers on the data extraction for the electronic medical charts. In addition, we would like to acknowledge Alberta Health Services for providing the data for the study. Finally, we would like to thank you the pediatric rheumatologists and patients at Alberta Children?s Hospital whose records were included in this review. This project was undertaken on behalf of the UCAN CAN-DU and UCAN CURE consortia.
Funding Information:
This work was supported by the Canadian Institutes for Health Research (Canada) [grant number 381280]; Genome Canada (Canada) [grant number OGI-150]; ZonMw (the Netherlands); and the Reumafonds (the Netherlands).
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/4/11
Y1 - 2022/4/11
N2 - OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSION: We observed a variety of treatment trajectories, with many patients experiencing multiple treatment lines, illustrating the complexity of the overall JIA treatment path.
AB - OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSION: We observed a variety of treatment trajectories, with many patients experiencing multiple treatment lines, illustrating the complexity of the overall JIA treatment path.
KW - Adolescent
KW - Antirheumatic Agents
KW - Arthritis, Juvenile/diagnosis
KW - Child
KW - Etanercept/therapeutic use
KW - Humans
KW - Methotrexate
KW - Retrospective Studies
KW - Treatment Outcome
KW - Disease modifying anti-rheumatic drugs
KW - Juvenile idiopathic arthritis
KW - Treatment patterns
KW - Biologic therapy
UR - https://www.scopus.com/pages/publications/85128221100
U2 - 10.1186/s12969-022-00682-x
DO - 10.1186/s12969-022-00682-x
M3 - Article
C2 - 35410419
SN - 1546-0096
VL - 20
SP - 1
EP - 11
JO - Pediatric rheumatology online journal
JF - Pediatric rheumatology online journal
IS - 1
M1 - 25
ER -