Patterns of etanercept use in juvenile idiopathic arthritis in the Childhood Arthritis and Rheumatology Research Alliance Registry

• Type of Material: Article
• Authors: Timothy Beukelman, University of Alabama Birmingham; Aimee Lougee, Duke Clinical Research Institute; Roland A. Matsouaka, Duke Clinical Research Institute; David Collier, Amgen Incorporated; Dax G. Rumsey, University of Alberta; Jennifer Schenfeld, Amgen Incorporated; Scott Stryker, Amgen Incorporated; Marinka Twilt, Cumming School of Medicine; Yukiko Kimura, Joseph M. Sanzari Children's Hospital; Cynthia Manos, Emory University; Sampath Prahalad, Emory University; Kelly Rouster Stevens, Emory University
• Language: English
• Date: 2021-12-01
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12969-021-00625-y
• Title of Journal or Parent Work: Pediatric Rheumatology
• Volume: 19
• Issue: 1
• Start Page: 131
• End Page: 131
• Grant/Funding Information: This analysis was supported by funding from Amgen.
• Keywords: Tumor Necrosis Factor Inhibitors; Child; Registry; Arthritis, juvenile; Duration of Therapy; Arthritis, Juvenile; Female; Registries; Immunosuppressive Agents; Methotrexate; United States; Paediatric rheumatology; Cohort studies; Etanercept; Anti-TNF; Medication Therapy Management; Clinical Protocols; Drug Monitoring; Drug Therapy, Combination; Humans; Male
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Immunology

Abstract

Background: We aimed to characterize etanercept (ETN) use in juvenile idiopathic arthritis (JIA) patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Methods: The CARRA Registry is a convenience cohort of patients with paediatric onset rheumatic diseases, including JIA. JIA patients treated with ETN for whom the month and year of ETN initiation were available were included. Patterns of ETN and methotrexate (MTX) use were categorized as follows: combination therapy (ETN and MTX started concurrently), step-up therapy (MTX started first and ETN added later), switchers (MTX started and then stopped when or before ETN started), MTX add-on (ETN started first and MTX added later), and ETN only (no MTX use). Data were described using parametric and non-parametric statistics as appropriate. Results: Two thousand thirty-two of the five thousand six hundred forty-one patients with JIA met inclusion criteria (74% female, median age at diagnosis 6.0 years [interquartile range 2.0, 11.0]. Most patients (66.9%) were treated with a non-biologic disease modifying anti-rheumatic drug (DMARD), primarily MTX, prior to ETN. There was significant variability in patterns of MTX use prior to starting ETN. Step-up therapy was the most common approach. Only 34.0% of persistent oligoarticular JIA patients continued treatment with a non-biologic DMARD 3 months or more after ETN initiation. ETN persistence overall was 66.3, 49.4, and 37.3% at 24, 36 and 48 months respectively. ETN persistence among spondyloarthritis patients (enthesitis related arthritis and psoriatic JIA) varied by MTX initiation pattern, with higher ETN persistence rates in those who initiated combination therapy (68.9%) and switchers/ETN only (73.3%) patients compared to step-up (65.4%) and MTX add-on (51.1%) therapy. Conclusion: This study characterizes contemporary patterns of ETN use in the CARRA Registry. Treatment was largely in keeping with American College of Rheumatology guidelines.