Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Etanercept in Juvenile Idiopathic Arthritis: Who Will Benefit? Results From the Dutch ABC Register.
Van Suijlekom-Smit1, Lisette W.A., Van Rossum10, Marion A.J., Wulffraat8, Nico M., Van den Berg9, J. Merlijn, Swart8, Joost F., Dolman7, Koert M., Gorter6, Simone L.
ErasmusMC Sophia Children's Hospital, Rotterdam, Netherlands
Emma Children's Hospital / Academic Medical Center (AMC), Amsterdam, Netherlands
Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Netherlands
Leiden University Medical Centre, Leiden, Netherlands
St Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
Hagaziekenhuis Juliana Children's Hospital, Den Haag, Netherlands
University Hospital Maastricht, Maastricht, Netherlands
St. Lucas Andreas Hospital and Reade Institute, Amsterdam, Netherlands
University Medical Center Utrecht, Utrecht, Netherlands
Emma Children's Hospital/ Academic Medical Centre and Reade Institute, Amsterdam, Netherlands
The pharmacological treatment approach for juvenile idiopathic arthritis (JIA) has changed substantially since the introduction of biologics with nowadays inactive disease as realistic goal. However, inactive disease is still not achieved by all patients. Identifying baseline factors which predict etanercept response could improve treatment strategies.
The Arthritis and Biologicals in Children (ABC) register (observational study, ongoing since 1999), includes all Dutch JIA patients who use or previously used biologics. Disease activity variables were retrieved prospectively at start of treatment, after 3 months, and yearly thereafter. Analyzed were all biologic-naive patients who started etanercept before October 2009 (n=262). Drug survival (i.e. median duration from start until first discontinuation due to ineffectiveness or adverse events (AEs)) was estimated with Kaplan-Meier analysis. Excellent response (inactive disease or earlier discontinuation due to disease remission) and poor response (less than 50% improvement from baseline, or earlier discontinuation due to ineffectiveness or intolerance) was evaluated 15 months after initiation of etanercept. A univariate and multivariate logistic regression analysis was performed to identify pre-defined potential baseline predictors for excellent and poor response and for occurrence of AEs.
Baseline characteristics: 71% female, 18% systemic-onset subtype, median age at onset 6.9 years. In the long-term (median follow-up duration, 35.6 months), the overall majority responded to etanercept and up to 40% reached inactive disease. The median drug survival was lower for the systemic-onset subtype (29.0 months, 95% CI 11.047.0) than for the non-systemic subtypes (76.8 months, 95% CI 45.7108.0). Reasons for discontinuation were: ineffectiveness in 78, AEs in 25, and remission in 39 patients. Excellent response after 15 months (85 patients, 32%) was associated with low baseline disability (OR 0.49/point increase, 95%CI 0.330.74), fewer disease-modifying anti-rheumatic drugs (DMARDs) used before etanercept (OR 0.64/DMARD used, 95%CI 0.430.95) and younger age at onset (OR 0.92/year, 95%CI 0.840.99). Poor response (88 patients, 34%) was associated with female gender (OR 2.12, 95%CI 1.114.08) and systemic-onset JIA (OR 3.24, 95%CI 1.397.56). However, 24% of systemic-onset JIA patients reached excellent response. Etanercept was well tolerated (0.05 serious AEs, 0.14 infectious AEs and 0.26 non-infectious AEs per patient-year of exposure). Patients developing AEs could not be identified at baseline.
In daily practice, etanercept is very effective and well tolerated by patients with JIA. Inactive disease was reached in up to 40% of the patients and was sustained years after initiation of etanercept. Excellent response was associated with baseline low disability and less DMARD use before etanercept. Therefore, the focus should be on strategies with early introduction of etanercept to further improve outcomes for JIA. The role of etanercept for systemic-onset JIA remains debatable. However, etanercept should not be rejected as a therapeutic option for this subtype.
To cite this abstract, please use the following information:
Van Suijlekom-Smit, Lisette W.A., Van Rossum, Marion A.J., Wulffraat, Nico M., Van den Berg, J. Merlijn, Swart, Joost F., Dolman, Koert M., et al; Etanercept in Juvenile Idiopathic Arthritis: Who Will Benefit? Results From the Dutch ABC Register. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :258