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.

Effectiveness and Safety of Switching Between Biologics in Juvenile Idiopathic Arthritis; Results From the Dutch ABC Register.

Otten1,  Marieke H., Prince2,  Femke H.M., Anink1,  Janneke, Van Rossum3,  Marion A. J., Hoppenreijs4,  Esther P.A.H., Gorter5,  Simone L., Armbrust6,  Wineke

ErasmusMC Sophia Children's Hospital, Rotterdam, Netherlands
Emma Children's Hospital/ Academic Medical Centre and Reade Institute, Amsterdam, Netherlands
Leiden University Medical Center, Leiden, Netherlands
ErasmusMC Sophia Childrens Hospital, Rotterdam, Netherlands
Brigham and Women's Hospital, Boston, MA
Emma Children's Hospital/Academic Medical Center (AMC), Amsterdam, Netherlands
St Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
University Hospital Maastricht, Maastricht, Netherlands
Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Netherlands
St. Lucas Andreas Hospital and Reade Institute, Amsterdam, Netherlands
Hagaziekenhuis Juliana Children's Hospital, Den Haag, Netherlands
University Medical Center Utrecht, Utrecht, Netherlands


The introduction of biologics has led to dramatic improvements in juvenile idiopathic arthritis (JIA). However, despite this treatment success, some patients need to discontinue these agents because of a lack of effectiveness or intolerance. Little is known about the effectiveness and safety of switching to a second or third biologic for JIA patients who failed their first.


The Arthritis and Biologicals in Children (ABC) register (observational study, ongoing since 1999), includes all Dutch JIA patients who use or previously used biologics. Data on the course of the disease are prospectively retrieved, including when biologics were discontinued or type of biologic switched, until transfer to the adult care. Drug survival (i.e. median duration from start until discontinuation due to ineffectiveness or adverse events (AEs)) for the first, second, and third course biologics was estimated with Kaplan-Meier. AE-rates within 1 year after start of the first, second and third course biologic were calculated.


Of the 411 JIA patients who started their first biologic, 88 patients (21%) switched to a second, and 28 (7%) patients to a third course biologic. Of the 88 patients who switched, 81 started etanercept as first biologic, and switched from etanercept to adalimumab (n=46), to infliximab (n=21) or to anakinra (n=14). Patients who also started a third course biologic most often switched between the anti-TNF-alpha agents only (n=19). The median follow-up duration since start of the second course biologic was 14.2 (4.2–29.4) months, and since start of the third course biologic 21.1 (IQR 3.4–33.6) months. Patients who switched to a second biologic had more often the systemic subtype (p<0.000), and at start of the first biologic higher disability scores (p=0.001) and more joints with arthritis (p<0.000) than patients who did not switch. Ineffectiveness of treatment (primary non-response or loss of response) was the most frequently reported reason for switching. At 12 months of treatment, drug survival of the first course biologics (83% (95% CI 79–87%)) was higher than for the second course (48% (95% CI 36–61%)), and third course 64% (95% CI 44–84%). The drug survival of the second course biologics was not different for subtype (systemic vs. non-systemic subtypes), type of second biologic started, and reason for switch. The AE-rates within 1 year after start were 0.21 AEs/patient-year for the first course, 0.20 AEs/patient-year for the second course, and 0.17 AEs/patient-year for the third course.


In daily practice, switching between biological agents occurred frequently. The observed switching patterns seem to be influenced by the availability of biologics within the study period. Risk factors for switching were the systemic-onset subtype and at start of the first biologic high disability scores and many joints with arthritis. While the drug survival of the first course was higher, still 48% of the switchers continued their second biologic after 12 months of treatment. Switching to a second (and third) course biologic seems to be safe and a reasonable option.

To cite this abstract, please use the following information:
Otten, Marieke H., Prince, Femke H.M., Anink, Janneke, Van Rossum, Marion A. J., Hoppenreijs, Esther P.A.H., Gorter, Simone L., et al; Effectiveness and Safety of Switching Between Biologics in Juvenile Idiopathic Arthritis; Results From the Dutch ABC Register. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :286

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