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While there are numerous agents approved for use in juvenile idiopathic arthritis, little is know about actual use biological disease-modifying antirheumatic drug (DMARD) use or switching in the biologic era. A cohort comparison study has shown that after an unsuccessful trial of a first biologic, changing to a second TNFi is as effective as switching to a non-TNFi biologic.
The study included polyarticular JIA patients in two UK cohorts: the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study [BSPAR-ETN] and the Biologics for Children with Rheumatic Diseases [BCRD].
From a total of 2361 patients enrolled, 1152 patients started their first biologic (91% on a TNFi).
Nearly 23% (270) were changed to a second biologic, and 5% (61) went on to a third biologic.
Of the 240 patients failing a first biologic, 194 (81%) started a second TNFi and 46 (19%) started a non-TNFi.
The outcomes showed no difference between those starting a second TNFi vs non-TNFi biologic with no statistical edge according to the ACR Pedi 90 response (adjusted odds ratio [OR] 2·5, 95% CI 0·8–7·9; p=0·11) or minimal disease activity (adjusted OR 1·6, 95% CI 0·6–3·8; p=0·33).
They found no evidence that switching to a second non-TNFi biologic was more beneficial than a second TNFi (nor was it inferior).