PP1. Factors associated with choice of first biologic among children with JIA: a combined analysis from two UK paediatric biologic registers

Abstract

Background: The management of JIA has been revolutionized by the introduction of biologics such as etanercept, UK approved in 2002, as well as others licensed for JIA (adalimumab, tocilizumab, abatacept) and those licensed for RA (rituximab, infliximab and anakinra). Etanercept is most often the first choice biologic in the treatment of JIA; however there may be occasions where etanercept is not the preferred choice, for reasons of either effectiveness or safety. Understanding how biologics are being selected will help inform future practice and research. Aims: To describe patients starting first-line biologics in UK children and young people (CYP) with JIA and explore possible reasons behind this choice. Methods: The British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN), established 2004, and the Biologics for Children with Rheumatic Diseases (BCRD) study, established 2010, are ongoing prospective observational cohorts, collecting detailed information on CYP starting either etanercept (BSPAR-ETN) or any other biologic (BCRD) for JIA. At start of therapy, demographic and disease information is collected. Biologic-naive patients registered on or after 01 January 2010 starting their first biologic were identified and baseline disease characteristics compared between therapies, using descriptive statistics. An additional cohort of CYP starting etanercept before 2010 were also included to analyse changes in etanercept prescribing since initial approval. Results: To 26 August 2014, 931 patients were recruited starting a first-line biologic [142 BCRD (583 before 2010; 789 BSPAR-ETN (206<2010)]. From 2010, CYP with systemic JIA (sJIA) were almost exclusively prescribed anakinra or tocilizumab. Choice between anti-TNF therapies was largely driven by uveitis prevalence (5% etanercept vs 70% adalimumab and 73% infliximab). CYP starting etanercept were also more likely to have a polyarticular subtype. Only half of the patients starting etanercept received concomitant MTX compared with the other biologics (68-89%). Compared with etanercept patients pre-2010, CYP starting etanercept from 2010 had shorter disease duration, were less likely to present with sJIA, lower rates of uveitis and were less likely to be receiving corticosteroids. Conclusion: Although etanercept remains the most common biologic prescribed for JIA, there has been a clear shift towards the use of alternative biologics, including unlicensed biologics, in certain patient situations, largely driven by disease subtype and the presence of uveitis. This channelling of certain children towards specific therapies will need to be considered both in terms of future comparative effectiveness studies and also as a guide to ongoing research priorities within rheumatology. Disclosure statement: H.E.F. reports Honoraria, travel bursaries and educational unrestricted grants from Pfizer, Abbvie, Roche, Novartis and Schering Plough unrelated to the present abstract. T.R.S. reports medical education grants unrelated to the present abstract. K.L.H. reports honoraria from Pfizer and Abbvie for work unrelated to the present abstract. All other authors have declared no conflicts of interest.