AB1006 DRUG SURVIVAL OF SYSTEMIC TREATMENTS IN JUVENILE IDIOPATHIC ARTHRITIS
Authors: L. Trives Folguera, I. Monteagudo, B. Serrano Benavente, L. R. Caballero Motta, A. M. Anzola, K. López Gloria, J. C. Nieto
Journal: Annals of the Rheumatic Diseases (2020)

Background: Juvenile idiopathic arthritis (JIA) comprises a group of inflammatory diseases that frequently requires systemic treatments. There are some studies that evaluate the systemic drug survival in adults with JIA; but there is scarce data about the drug survival in paediatric population. Objectives: Our main objective was to study the drug survival of biologic therapies and synthetic DMARD in a monocentric cohort and the related factors influencing on it. Methods: Patients with JIA visited in the last 12 years were included. We carried out a retrospective, longitudinal study and collected data on treatment (start date, tapering and stop the treatment date; causes of finish and combined treatment or not). We also collected demographic data with date of birth, sex, symptoms onset data and JIA subcategory. We studied time to relapse since the drug suspension. The drug survival for each kind of treatment was analyzed with Kapplan-Meier curves. Results: We included 158 patients with JIA. Demographic data are shown in table 1. One hundred and thirty (82.3%) patients started methotrexate (MTX) with a half-life of 34.8 months; 79 (51.5%) patients started biologic therapy with half-life of 29 months and 14 (17.7%) patients started a second biologic with a half-life of 5 months. Time to first tapering of MTX was 12 months, for the first biologic was 10.5 months and for the second biologic was of 15 months. The main cause of suspension was remission for each group. Treatment according to different JIA subcategories is shown in table 2. In 45 patients (28.5%) systemic treatment was stopped and 11 (24.4%) had a disease flare in a mean time of 36 months. Taking into account only patients who flared, the mean time was 15.6 months. Table 1. Overview of patients with BSLE. BMZ: basal membrane zone MTP: methylprednisolone DDS: dapsone Table 1. Demographic features of the patients. Total (n:158) Sex (female) 96 (60,76%) Starting age (median y RI) 4,9 (2,6-9,8) AAN positives 91 (57,6%) JIA oligo persistent 66 (41,77%) JIA oligo extended 16 (10,13%) JIA enthesitis 14 (8,86%) JIA psoriasic 9 (5,7%) JIA systemic 18 (11,39%) JIA poli FR- 29 (18,35%) JIA poli FR+ 4 (2,53%) JIA undifferentiated 2 (1,27%) Table 2. All diseases that are diagnosed in patients during the follow-up period. Group 1 (Systemic JIA n=18 (%) Group 2 (Oligoarticular JIA n=82 (%) Group 3 (Poliarticular JIA n=33 (%) Group 4 (Juvenil SpA n=23 (%) Synthetic DMARD (n:130) 9 (50%) 71 (86,6%) 33 (100%) 17 (74%) Biologic Therapy (n:79) 6 (33,3%) 34 (41,46%) 22 (75%) 17 (74%) No systemic treatment (n:21) 7 (38,9%) 10 (12,2%) 0 4 (17.4%) Fig 1. Histology and DIF of BSLE H-E a and b : subepidermal blisters c and d : abundant neutrophils are observed e : DIF full house linear pattern Fig 2. skin lesions of BSLE a : tense serous blisters, scars and erosions b : purpuric macules in palms c : blisters in groin d-g : blisters and hypopigmented scars Conclusion: The drug survival for systemic therapies in children with JIA is more than 2 years, without significant differences between synthetic DMARDs and biologics. Remission is the main cause for ending treatment. Biologic drug survival was significantly shorter between systemic JIA and the other subcategories. Only one fourth of patients had a flared after stopping the systemic treatment. Disclosure of Interests: Laura Trives Folguera Speakers bureau: ROCHE, Indalecio Monteagudo: None declared, Belén Serrano Benavente: None declared, Liz R. Caballero Motta: None declared, Ana Melissa Anzola: None declared, Katerine López Gloria: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi