Which biologic drugs are used, and how well do they work, in children and young people with JIA

What is it about?

Juvenile idiopathic arthritis (JIA) is a painful debilitating inflammatory arthritis affecting children and young people. Biologic therapies have become a main treatment option of children and young people with JIA. There is a wide choice of biologic therapies available and they may not all work for all patients. For some patients, treatment with their first biologic does not control their arthritis and they will have to try other biologics until their arthritis is finally controlled. The extent to which children and young people are switch between biologic therapies, and which biologic is best if a patient’s first doesn’t work, is unknown. The aim of this analysis was to address both of these questions using data from a large study of children and young people from the United Kingdom who are receiving biologics for their JIA and is the first paper to tackle these issues to this extent. What was discovered? This analysis includes 2361 children and young people with JIA enrolled in one of two UK studies: the Biologics for Children with Rheumatic Diseases (BCRD) study and the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN). Of those starting their first biologic, followed for an average of 2.2 years, 23% went on to start a second biologic, and 5% received at least three biologics. Of those children and young people who required multiple biologics (at least three different ones), six-in-every eight received two tumour necrosis factor (TNF) inhibitor biologics (biologics in the same class but which work a bit differently) before trying a different class of biologic. In children where a first TNF inhibitor was ineffective, there was no difference in how well they responded to therapy whether they started a second TNF inhibitor, or switched to a different class of biologic therapy.

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Photo by freestocks on Unsplash

Photo by freestocks on Unsplash

Why is it important?

Current UK guidelines from NHS England recommend children and young people with JIA switch to a second TNF inhibitor if the first was ineffective. This is in contrast to the American guidelines which recommend switching to a different class instead. Based on this analysis there is no evidence to support or refute either of the guidelines. Repeat analysis with a larger sample size is require to validate these finding.

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