Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting

Tarkiainen, Maarit; Tynjälä, Pirjo; Vähäsalo, Paula; Lahdenne, Pekka

doi:10.1093/rheumatology/keu457

Cited by 73 publications

(70 citation statements)

References 11 publications

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“…In this registry, however, all JIA subtypes with various comorbidities are included and this may explain the difference. In agreement with previous studies, infections represented the most frequent AE for both ADA and IFX 6,12,15 .…”

Section: Rheumatologysupporting

confidence: 92%

Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Cecchin

Zannin²,

Ferrari³

et al. 2018

J Rheumatol

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Objective.Anti-TNF-α agents have significantly changed the management of juvenile idiopathic arthritis (JIA). We evaluated the safety and efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of JIA-associated uveitis in patients treated for ≥ 2 years.Methods.Patients with JIA-associated uveitis treated with IFX and ADA were managed by a standardized protocol and data were entered in the ORCHIDEA registry. At baseline, all patients were refractory to standard immunosuppressive treatment or were corticosteroid-dependent. Data recorded every 3 months were uveitis course, number/type of ocular flares and complications, drug-related adverse events (AE), and treatment switch or withdrawal. Data of patients treated for ≥ 2 years were analyzed by descriptive statistics.Results.Up to December 2014, 154 patients with ≥ 24 months followup were included in the study. Fifty-nine patients were treated with IFX and 95 with ADA. Clinical remission, defined as the absence of flares for > 6 months on treatment, was achieved in 69 patients (44.8%), with a better remission rate for ADA (60.0%) as compared to IFX (20.3%; p < 0.001). A significant reduction of flares was observed in all patients without difference between the 2 treatment modalities. The number of new ocular complications decreased in both groups but was lower for ADA (p = 0.015). No serious AE were recorded; 16.4% of patients experienced 35 minor AE and the incidence rate was lower with ADA than with IFX.Conclusion.At the 2-year followup, ADA showed a better efficacy and safety profile than IFX for the treatment of refractory JIA-associated uveitis.

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Section: Rheumatologysupporting

confidence: 92%

Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Cecchin

Zannin²,

Ferrari³

et al. 2018

J Rheumatol

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“…The absolute number of occurrences is fortunately low, and malignancies in other cohorts are low or absent, similar to our study (18, 24). …”

Section: Discussionsupporting

confidence: 90%

Population-based study of outcomes of patients with juvenile idiopathic arthritis (JIA) compared to non-JIA subjects

Krause

Zamora-Legoff

Crowson

et al. 2017

Seminars in Arthritis and Rheumatism

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Objective Evaluate healthcare utilization and occurrence of comorbidities in a population-based cohort of patients of juvenile idiopathic arthritis (JIA) with an age- and sex-matched comparator group. Methods Prevalent cases of JIA in 1994–2013 were identified in Olmsted County, Minnesota along with age- and sex-matched non-JIA comparators. Surgeries, hospitalizations, pregnancies, and comorbidities were identified by medical record review. Poisson methods were used to generate rate ratios (RR) with 95% confidence intervals (CI) to compare outcomes between JIA and non-JIA cohorts separately during childhood (age<18 years) and adulthood (age≥18 years). Results Eighty-nine JIA and 89 non-JIA comparators were identified (64% female; mean [SD] age 8.6[5.1] years at JIA incidence/index date and mean follow-up in childhood 6.3[4.4] years for JIA; similar for comparators). Thirty-eight pairs had follow-up into adulthood with mean follow-up of 8.0[5.5] years for JIA. Children with JIA were more likely to have joint surgery (RR:3.93, 95%CI:1.18–24.94), non-joint surgery (RR:1.90, 95%CI:1.05–3.67), and hospitalizations (RR:2.25, 95%CI:1.04–5.53) than non-JIA comparators. As adults only joint surgeries remained significantly different (RR:8.5, 95%CI:2.27–120.1). Depression during childhood was more common in JIA (RR:2.49, 95% CI:1.01–6.13). There were no differences in educational achievement, employment status or pregnancy outcomes between the 2 groups. Conclusions In a population-based cohort, inpatient healthcare utilization is higher for patients with JIA including surgery and hospitalization during childhood but not extending into adulthood. Understanding long-term comorbidities and healthcare needs for patients with JIA is necessary to provide comprehensive care.

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“…This recommendation was conditional based on the low quality of supporting evidence and parent and patient preferences regarding the risks and benefits of DMARDs and biologic medications (29,58,61,64,65,67,(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). In patients with JIA and polyarthritis and moderate or high disease activity despite DMARD monotherapy, adding a biologic to the original DMARD is conditionally recommended over changing to a second DMARD.…”

Section: Physical Therapymentioning

confidence: 99%

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non‐Systemic Polyarthritis, Sacroiliitis, and Enthesitis

Ringold

Angeles‐Han

Beukelman

et al. 2019

Arthritis & Rheumatology

138

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Objective. To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis.Methods. The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions.Results. Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the health care provider in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes, but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision, as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions. These recommendations cannot adequately convey all uncertainties and nuances of patient care.The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service. RINGOLD ET AL 718 |recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies.Conclusion. This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny a...

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Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting

Abstract: Mild and moderate AEs in patients with JIA treated with biologics were more frequent than previously reported. SAEs were observed in one-third of the patients, but SAEs seldom led to drug discontinuation.

Cited by 73 publications

References 11 publications

Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Population-based study of outcomes of patients with juvenile idiopathic arthritis (JIA) compared to non-JIA subjects

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non‐Systemic Polyarthritis, Sacroiliitis, and Enthesitis

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