AB0987 CHOICE AND SWITCH BETWEEN BIOLOGICAL AGENTS IN NON-SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS (JIA)
Authors: Anna Ignatova, Nina Seylanova, Elena Zholobova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Over the past few decades, biologic therapy has significantly improved the prognosis in children with JIA. The issue of optimal and personalised biologics prescription and the problem of switching between drugs are relevant questions of modern paediatric rheumatology. <h3>Objectives</h3> The aim of our retrospective observation was to describe trends in the biologics prescription in first and subsequent lines for the treatment of non-systemic JIA. <h3>Methods</h3> We recruited 252 patients with non-systemic JIA, who received medical treatment with biologics at the Department of Paediatric Rheumatology of Sechenov University from January 2015 to December 2017. 18% of them (n=46) had chronic anterior uveitis at the moment of biologic therapy initiation. Eye involvement influenced treatment decisions in these patients, and therefore they were excluded from the analysis. 206 children with non-systemic JIA and without uveitis were included in a study group. Patients' characteristics: 128 girls and 78 boys (1,6/1). Mean age 13,5 ± 3,8 years, age of disease onset 7,8 ± 4,2 years; mean disease duration before biologic therapy initiation 3,3 ± 3,4 years. JIA categories: 135 (65,5%) had polyarticular RF-, 29 (14,1%) – oligoarticular, 26 (12,6%) – enthesitis-related, 9 (4,4%) – polyarticular RF+, and 7 (3,4%) – psoriatic subtype. At baseline, 204 patients (99,0%) received concomitant therapy with conventional DMARDs: 175 children (85,0%) received Methotrexate (MTX), 3 (1,5%) – combination of MTX and sulfasalazin (SSZ), 9 (4,4%) – SSZ, 9 (4,4%) – leflunomid, 4 (1,9%) – combination of MTX and leflunomid, 4 (1,9%) – cyclosporine A. Two children (1,0%) received biologics as monotherapy. <h3>Results</h3> As a first biologic abatacept was used in 26 patients, adalimumab in 14, tocilizumab in 6 and infliximab in 4. Etanercept was prescribed to 156 patients (75,7%± 3,5) with non-systemic JIA, which was significantly more frequently than other biologics together – 50 (24,3%± 6,2) (t=7,1; P&gt;99,7%). Later 24 children (11,7%) were switched from a first to a second biologic agent. The main reason for switching (n=14) was inefficacy of the first-line drug. When etanercept was ineffective, abatacept (n=3) and adalimumab (n=5) were prescribed as second-line biologics. Etanercept was used as a second-line biologic in 6 children, who were initially treated with other biologic agents. The other reason for switching was the appearance of chronic anterior uveitis (n=7): 6 of these children were initially treated with etanercept, 1 with abatacept; they were switched to adalimumab (n=6) and abatacept (n=1). In 2 cases adverse events were observed – one episode of intrathoracic lymphatic nodes tuberculosis in a patient receiving etanercept, and one allergic reaction (rush, asphyxia) after the infliximab injection. At the end of our observation etanercept was chosen as treatment for 148 (71,8%) patients with non-systemic JIA. <h3>Conclusion</h3> Thus, etanercept was preferred biologic agent in the treatment of non-systemic JIA. The presence of uveitis requires a different treatment approach. <h3>References</h3> [1] Kearsley-Fleet, et al. Factors associated with choice of biologic among children with JIA: results from two UK paediatric biologic registers. Rheumatology (Oxford).2016;55:1556-1565 <h3>Disclosure of Interests</h3> Anna Ignatova: None declared, Nina Seylanova: None declared, Elena Zholobova Grant/research support from: Roche, Pfizer, Novartis, Consultant for: Pfizer, AbbVie, Roche, BMS, Novartis, MSD, Speakers bureau: Pfizer, AbbVie, Roche, BMS, Novartis, MSD