NEW YORK (Reuters Health)—For young people with juvenile idiopathic arthritis (JIA) who don’t achieve disease control, switching to a different class of biologic is unlikely to be beneficial, researchers say.
The observational study yielded no evidence to support or refute the 2015 National Health Service England guidelines, which recommend switching most patients to a second TNF inhibitor, or the 2019 guidelines of the ACR, which recommend switching patients to an alternative class of biologic (e.g., tocilizumab or abatacept).
“There are differing opinions on which biologic drugs [these children] should receive, and in which order, should they not respond to or be intolerant of methotrexate and a first biologic, often an anti-TNF,” Dr. Kimme Hyrich of the University of Manchester, UK, tells Reuters Health by email. “Our study found after a first biologic, usually a TNF inhibitor, similar outcomes were seen after one year between children who started a second anti-TNF or an alternative class, primarily the IL-6 inhibitor tocilizumab.”
Due to the study’s small size, she notes, “it was not possible to study further whether there are certain children who may still benefit more than others from switching class.”
“This emphasizes the need to continue to recruit children into clinical studies so that a large evidence base can be generated to better inform practice for this relatively uncommon disease,” she adds.
As reported in The Lancet Rheumatology, Dr. Hyrich and colleagues analyzed 2,361 young people enrolled upon initiation of biologic therapy in two parallel UK cohort studies between 2004 and 2019.1
From 2010 onwards, 1,152 patients started their first biologic, mostly (91%) with TNF inhibitors. The median follow-up was 2.2 years, during which time, 270 (23%) started a second biologic; 61 (5%) started a third biologic; and 11 (1%) started a fourth.
In a subgroup of 240 patients with polyarticular course juvenile idiopathic arthritis, 194 (81%) started a second TNF inhibitor and 46 (19%) started a different class of biologic after an initial TNF inhibitor failed.
The choice of second therapy – i.e., second TNF inhibitor or another class of biologic—did not affect the proportion of patients who achieved an ACR Pediatric (ACR Pedi) 90 response (adjusted odds ratio, 2.5) or minimal disease activity (aOR, 1.6).
The authors note that the study did not capture data on treatment adherence, drug levels, or anti-drug antibody concentrations, which might have influenced treatment response – nor was the route or frequency of biologic administration investigated, which might have influenced treatment choice.