AB1064 LONG-TERM SAFETY AND EFFICACY OF ADALIMUMAB IN GREEK ADULTS WITH JIA OR NON-INFECTIOUS UVEITIS AT THE TRANSITION PERIOD

Abstract

Background: Our previous publication on Juvenile Idiopathic Arthritis (JIA) revealed that half of the pts had flares in adulthood, despite previous administration of several anti-TNFs. Objectives: a. To describe the long-term outcome of adults with JIA or non-infectious uveitis (NIU), exposed to Adalimumab (ADA) as the single or last biologic during the transition period. b. To evaluate our model of transition in a subgroup of refractory to conventional DMARDs JIA or NIU pts, in the 1st Greek Transition Clinic for Pediatric Rheumatic Diseases. Methods: Retrospective cohort analysis of Greek adults with JIA or NIU between 2004 and 2018. The JIA activity state was assessed by 2 quantitative tools: the Juvenile Arthritis Disease Activity Score-10 (JADAS-10, Clinical Remission [CR], Low, Moderate and High Disease Activity [LDA, MDA, HDA], respectively) and Wallace criteria (CR on/off ADA). Baseline was defined as the 1st ADA dose Results: 28 pts were enrolled: 24 JIA pts (female 18), aged 20.6±3.1 yrs, for a f/u of 6.5±3 years (Group-A) and 4 female pts with active uveitis (2 with JIA-associated and 2 with NIU, mean aged: 18.9 yrs, f/u: 2.3 yrs) (Group-B). The age at baseline was 14.1±3.2 yrs in Group-A and 16.7 yrs in Group-B. The lag time from JIA onset to baseline was 6.3±3.8 yrs and the JIA subtypes were: 37.5% polyarthritis RF neg, 33.3% extended oligoarthritis, 20.8% enthesitis-related arthritis, 4.2% persistent oligoarthritis, 4.2% psoriatic arthritis. 11/24 (45.8%) pts (Group-A) and 3/4 pts (Group-B) were ANA positive, 5/24 JIA-pts had a history of uveitis (20.8%). Naïve to anti-TNF drugs were 18 pts (75%) of Group-A and 4/4 from Group-B. The baseline JADAS-10 was 13.9±5.9. The ADA yr-administration was 5.3±2.3 in Group-A and 2 in Group-B. Compliance to ADA had 17/24 (70.8%) pts in Group-A and all from Group-B. Regarding safety, 4/28 patients (14.3%) experienced Events of Special Interest (1/33.6 patient-years), herpes zoster (n=1), anorexia nervosa (n=1), breast fibroadenoma (n=1) and uveitis (n=1). Among the Group-A pts: 4/24 (16.7%) discontinued ADA due to inefficacy and 1/24 due to pregnancy planning. 6/24 pts (25%) achieved CR and discontinued ADA after 5.3 ±1.6 yrs. CR off ADA lasted 15.5±9.8 mo. The rest 13/24 continued ADA at the last f/u. In Group-B, 3/4 were still on ADA and 1 pt discontinued ADA due to NIU remission after 4.2 yrs and sustained CR 16 mo off ADA. The median% of CR remission on ADA total administration period was 75% in Group-A and 100% in Group-B. Among the ongoing receivers: a) the JIA activity state at the last assessment was: CR 84.6%, LDA 7.7% MDA 7.7% (median JADAS: 0, Group-A), b) 100% were in remission in Group-B. Conclusion: 86% of adult pts with JIA or NIU tolerate ADA well. Pts exposed to ADA achieved CR on/off medication in 75% and 25%, respectively.