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Trends towards more active introduction of drug therapy, emphasizing methotrexate and biologic agents, for juvenile idiopathic arthritis

  • Heini PohjankoskiEmail author
  • Hannu Kautiainen
  • Juhani Virta Lauri
  • Kari Puolakka
  • Vappu Rantalaiho
Brief Report
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Abstract

To evaluate the drug treatment trends in patients with incident juvenile idiopathic arthritis (JIA) in 2006–2014. In Finland, patients are entitled to a special reimbursement for medication if their condition meets certain criteria. We gathered all reimbursement decisions with the ICD-10 diagnosis of M08 for patients under 16 years of age from a nationwide register maintained by Kela, the Social Institution of Finland. A total of 2439 incident cases of JIA were identified. We surveyed their reimbursable drugs purchased for the first time for JIA upon a doctor’s prescription in 3-year cohorts (2006–2008, 2009–2011, 2012–2014). Changes of drug treatment for JIA became more active during our study years. Between 2006–2008 and 2011–2014, the introduction of methotrexate (MTX) for the first time within the first 3 months increased from 73% (2006–2008) to 90% (2011–2014) of the patients, IRR (incidence rate ratio) was 1.23 (95% CI 1.10–1.37). The use of parenteral MTX increased even more; IRR was 1.97 (95% CI 1.61–2.41). During the first 2 years of their disease, 18% of the first cohort received subcutaneous biologic agents, while the corresponding proportion in the last cohort was 31%. Biologic agents were more likely to be introduced for patients with early (3 months) MTX administration than for patients without early MTX introduction; HR (hazard ratio) 2.19 (95% CI 1.63–2.93). During the follow-up, MTX administration became more prevalent for the treatment of JIA soon after diagnosis, mostly because of the increase in the use of parenteral MTX.

Key Points

The drug therapy for treating juvenile idiopathic arthritis has changed during recent years.

Methotrexate, some other conventional DMARDs, and biologic DMARDs are introduced earlier.

Keywords

Biologic DMARDs Conventional DMARDs Drug therapy Juvenile idiopathic arthritis Methotrexate 

Notes

Authorship criteria

All authors contributed to study conception and design. Lauri Virta and Hannu Kautiainen acquisitioned the data. Heini Pohjankoski and Hannu Kautiainen analyzed and all authors contributed to interpretation of data. Heini Pohjankoski drafted the article. All authors revised and approved the final version of the article.

Funding information

This study was supported by the Medical Research Fund of Päijät-Häme Central District Hospital. Heini Pohjankoski has received travel and congress fees from Pfizer, AbbVie, MSD, and Roche. Kari Puolakka has received travel and congress fees from BMS and Roche and consulting fees from Lilly, MSD, Novartis, and Sanofi, as well as payments for lectures from Abbvie, Mylan, Pfizer, and UCB. Vappu Rantalaiho reports grants from the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and from Tampereen Reumayhdistys during the conduct of the study, as well as a speaker’s honorarium and a congress trip from Pfizer, in addition to a congress trip from Celegen outside the submitted work. Hannu Kautiainen and Lauri Virta do not have any conflicts of interest.

Compliance with ethical standards

Disclosures

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Department of PediatricsPäijät-Häme Central HospitalLahtiFinland
  2. 2.Primary Health Care UnitKuopio University HospitalKuopioFinland
  3. 3.Folkhälsan Research CenterHelsinkiFinland
  4. 4.Kela ResearchThe Social Insurance Institution of FinlandTurkuFinland
  5. 5.Department of MedicineSouth Karelia Central HospitalLappeenrantaFinland
  6. 6.Centre for Rheumatic Diseases, Tampere University Hospital, and Faculty on Medicine and Health TechnologyTampere UniversityTampereFinland

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