Skip to main content

Advertisement

SpringerLink
Log in

Approach to switching biologics in juvenile idiopathic arthritis: a real-life experience

  • Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

The data underlying this article will be shared upon all reasonable requests to the corresponding author.

Code availability

Not applicable.

References

  1. Minden K, Niewerth M, Listing J, Zink A, German Study Group of Pediatric R (2002) Health care provision in pediatric rheumatology in Germany–national rheumatologic database. J Rheumatol 29:622–628

    PubMed  Google Scholar 

  2. Petty RE, Southwood TR, Manners P et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  3. Ringold S, Weiss PF, Beukelman T et al (2013) 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis Rheum 65:2499–2512

    Article  Google Scholar 

  4. Beukelman T, Patkar NM, Saag KG et al (2011) 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) 63:465–482

    Article  Google Scholar 

  5. Quartier P (2016) Choice of biologic drug among children with juvenile idiopathic arthritis. Rheumatology (Oxford) 55:1534–1535

    Article  Google Scholar 

  6. Ringold S, Angeles-Han ST, Beukelman T et al (2019) 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 Care Res (Hoboken) 71:717–734

    Article  Google Scholar 

  7. Consolaro A, Ruperto N, Bazso A et al (2009) Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum 61:658–666

    Article  Google Scholar 

  8. McErlane F, Beresford MW, Baildam EM et al (2013) Validity of a three-variable Juvenile Arthritis Disease Activity Score in children with new-onset juvenile idiopathic arthritis. Ann Rheum Dis 72:1983–1988

    Article  Google Scholar 

  9. Consolaro A, Ravelli A (2016) Defining criteria for disease activity states in juvenile idiopathic arthritis. Rheumatology (Oxford) 55:595–596

    Article  Google Scholar 

  10. www.toraks.org.tr.

  11. Cimaz R, Maioli G, Calabrese G (2020) Current and emerging biologics for the treatment of juvenile idiopathic arthritis. Expert Opin Biol Ther 20:725–740

    Article  CAS  Google Scholar 

  12. Poddighe D, Romano M, Gattinara M, Gerloni V (2018) Biologics for the treatment of juvenile idiopathic arthritis. Curr Med Chem 25:5860–5893

    Article  CAS  Google Scholar 

  13. Marchesoni A, Zaccara E, Gorla R, Bazzani C, Sarzi-Puttini P, Atzeni F, Caporali R, Bobbio-Pallavicini F, Favalli EG (2009) TNF-alpha antagonist survival rate in a cohort of rheumatoid arthritis patients observed under conditions of standard clinical practice. Ann N Y Acad Sci 1173:837–846

    Article  CAS  Google Scholar 

  14. Kearsley-Fleet L, Davies R, De Cock D, Watson KD, Lunt M, Buch MH, Isaacs JD, Hyrich KL, Group B-RC (2018) Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis 77:1405–1412

    Article  Google Scholar 

  15. Todoerti M, Favalli EG, Iannone F et al (2018) Switch or swap strategy in rheumatoid arthritis patients failing TNF inhibitors? Results of a modified Italian Expert Consensus. Rheumatology (Oxford) 57:42–53

    Article  Google Scholar 

  16. Mannion ML, Xie F, Horton DB, Ringold S, Correll CK, Dennos A, Beukelman T, Investigators CR (2020) Biologic switching among non-systemic juvenile idiopathic arthritis patients: a cohort study in the childhood arthritis and rheumatology research alliance registry. J Rheumatol. https://doi.org/10.3899/jrheum.200437

    Article  PubMed  Google Scholar 

  17. Kearsley-Fleet L, Heaf E, Davies R et al (2020) Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study. Lancet Rheumatol 2:217–226

    Article  Google Scholar 

  18. Otten MH, Prince FH, Anink J et al (2013) Effectiveness and safety of a second and third biological agent after failing etanercept in juvenile idiopathic arthritis: results from the Dutch National ABC Register. Ann Rheum Dis 72:721–727

    Article  CAS  Google Scholar 

  19. Kasapçopur Ö, Barut K (2015) Treatment in juvenile rheumatoid arthritis and new treatment options treatments. Turk Pediatri Ars 50:1–10

    Article  Google Scholar 

  20. Kubota T, Imanaka H, Takei S et al (2016) Disease activity score in 28 joints at 3 months after the initiation of biologic agent can be a predictive target for switching to the second biologic agent in patients with polyarticular juvenile idiopathic arthritis. Mod Rheumatol 26:358–361

    Article  CAS  Google Scholar 

Download references

Funding

No specific funding was received to carry out the work described in this article from any bodies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Pediatric Rheumatology, University of Health Sciences, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey

    Şerife Gül Karadağ & Rahime Koç

  2. Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul University Medical School, Fatih, Istanbul, Turkey

    Fatma Gül Demirkan, Figen Çakmak & Nuray Aktay Ayaz

  3. Department of Pediatric Rheumatology, Kocaeli Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey

    Hafize Emine Sönmez

Authors
  1. Şerife Gül Karadağ
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fatma Gül Demirkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rahime Koç
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Figen Çakmak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hafize Emine Sönmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nuray Aktay Ayaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization—SGK NAA; design of the work—SGK, FGD, RK, FC, HES, and NAA; data analysis—SGK, HES, NAA. All authors made substantial contributions to interpretation of data for the work. All authors were involved in drafting the article or critically revising it, and all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Nuray Aktay Ayaz.

Ethics declarations

Conflict of interest

The authors declare there are no conflicts of interest—financial or otherwise—related to the material presented herein.

Ethical approval

The study was conducted in accordance with Good Clinical Practice Guidelines and the Declaration of Helsinki, with the necessary approval of the local ethics committee (ethics approval number: KAEK/2019.01.06).

Informed consent

Informed consent was obtained from the patients’ legal guardians.

Consent for publication

The patients’ legal guardians provided written informed consent regarding publishing their data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karadağ, Ş.G., Demirkan, F.G., Koç, R. et al. Approach to switching biologics in juvenile idiopathic arthritis: a real-life experience. Rheumatol Int 42, 141–147 (2022). https://doi.org/10.1007/s00296-021-04854-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-021-04854-y

Keywords

Search

Navigation