THU0513 MEDICATION BURDEN IN YOUNG ADULTS WITH JUVENILE IDIOPATHIC ARTHRITIS – RESULTS OF AN OBSERVATIONAL COHORT STUDY
Authors: L. Montag, J. Klotsche, M. Niewerth, S. Tatsis, E. Seipelt, P. Hoff, G. Horneff, K. Minden
Journal: Annals of the Rheumatic Diseases (2020)

Background: Juvenile idiopathic arthritis (JIA) often persists into adulthood, and many young adults with JIA still need antirheumatic medication. Rheumatologists prescribe DMARDs and glucocorticoids, but are not always aware of other medications taken by patients concurrently. Self-reported medication use was used to obtain information on drug exposure of young adults with JIA. Objectives: To evaluate medication use in a large cohort of young adults with JIA ever treated with DMARDs. Methods: Patients ever treated with DMARDs and prospectively observed in the JIA biologic registry JuMBO were asked about their drug consumption at each JuMBO visit. In addition, patients reported their current health status in terms of disease activity and pain (scored on numerical rating scales 0-10), functional ability (by HAQ) and quality of life (by SF-36). The Anatomical Therapeutic Chemical Classification System for medicinal products (ATC) was used to classify self-reported medication use. Local therapies, with the exception of ophthalmological drugs, and cough and cold remedies were not included. Results: A total of 1,306 young adults (68% female) with JIA and a mean disease duration of 13.6±6 years (ys) were included in the analysis. The majority of them were classified as polyarticular-onset JIA (35.6%), 20.5% as enthesitis-related arthritis. At the last follow-up (FU), the patients´ mean age was 23.1±4.1 ys. They had received a mean of 2.6±1.4 DMARDs, 79% were ever treated with biologics. At FU, patients used on average 1.9±1.8 drugs. About one in five patients (296, 22.7%) reported no medication use at all, 367 (28.1%) reported only DMARD use. The most frequently reported drugs were DMARDs (64%), NSAIDs (48%), glucocorticoids (19%), followed by analgesics (10.6%), drugs for acid-related disorders (6.9%) and anti-infectives for systemic use (6.1%). Antidepressant drug use reported 3.4% and antihypertensive drug use 3.1% of the patients. Women used significantly more frequently NSAIDs, glucocorticoids, non-opioid analgesics and thyroid medication. There were 178 (14%) patients who received at least 3 other medications in addition to DMARDs. This patient group frequently reported the use of pain medication (74% NSAIDs, 23% non-opioid analgesics, 20% opioid drugs) and antidepressants (16%) and had been treated late with bDMARDs (7.4±4.9 ys after symptom onset). There were significant differences in drug usage between patients with various JIA categories (table). Moreover, the use of glucocorticoids, antihypertensives and antidepressants in adulthood (adjusted by propensity scores) increased with longer time from symptom onset to bDMARD start. Table. Self-reported medication use in patients with different JIA categories at the last JuMBO FU Sys JIA OA, pers. OA, ext. RF- PA RF+ PA ERA PsA Other arthritis P value N= 66 N=117 N=227 N=350 N=115 N=268 N=116 N=47 Drugs per patient, mean 2.7±2.2 1.3±1.6 2.2±2.0 1.8±1.8 2.7±2.0 1.5±1.5 1.9±1.7 1.7±1.8 &lt;0.001 Drugs, in % DMARDs 68 45 74 60 87 60 62 57 &lt;0.001 bDMARDs 59 32 64 48 73 53 53 47 &lt;0.001 sDMARDs 27 25 34 28 46 21 29 23 &lt;0.001 Glucocorticoids 32 10 23 19 35 10 19 17 &lt;0.001 NSAIDs 36 36 52 48 55 44 55 55 0.008 Drugs for acid related disorders 6 3 8 7 7 6 8 15 0.314 Analgesics 12 6 11 13 14 8 10 11 0.198 Opioids 9 2 4 4 4 2 2 4 0.181 Antiinfectives 9 4 7 7 3 6 7 6 0.641 Antidepressants 6 3 5 3 1 5 3 0 0.319 Antihypertensives 11 1 3 3 5 2 3 6 0.005 Antithrombotics 5 1 1 1 4 0.4 0 0 0.027 Conclusion: Self-reported medication use adds important information when assessing the long-term outcome of JIA. About 15% of JIA patients ever exposed to DMARDs, especially those with late start of bDMARD therapy, have a high medication or disease burden in young adulthood. Acknowledgments: JUMBO - joint unconditional grant from Pfizer, Abbvie, Roche Disclosure of Interests: Laura Montag: None declared, Jens Klotsche: None declared, Martina Niewerth: None declared, Stefanie Tatsis: None declared, Eva Seipelt: None declared, Paula Hoff Consultant of: BMS, Amgen, Speakers bureau: Novartis, Jansen, Pfizer, Mylan, BMS, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche