Effectiveness and safety of a second and third biological agent after failing etanercept in juvenile idiopathic arthritis: results from the Dutch National ABC Register
Effectiveness and safety of a second and third biological agent after failing etanercept in juvenile idiopathic arthritis: results from the Dutch National ABC Register
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DOI：
10.1136/annrheumdis-2011-201060
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发表时间：
2013-05-01
影响因子：
27.4
通讯作者：
van Suijlekom-Smit, Lisette W. A.
中科院分区：
文献类型：
--
作者：
Otten, Marieke H.;Prince, Femke H. M.;van Suijlekom-Smit, Lisette W. A.
目的评价依那西普治疗失败后改用第二或第三生物制剂治疗幼年特发性关节炎（JIA）的有效性和安全性。方法《儿童关节炎和生物制剂登记表》旨在纳入所有使用过生物制剂的荷兰JIA患者。病程数据用于Kaplan-Meier法估计药物生存期，并计算不良事件（AE）发生率。结果在307例开始使用依那西普的生物学新手JIA患者中，80例（26%）改用第二种生物制剂，22例（7%）改用第三种生物制剂。在引入依那西普后的1030例患者年随访中，对49例改用阿达木单抗、28例改用英夫利昔单抗、17例改用阿那那单抗、4例改用阿巴接受和4例试验药物进行了评估。84% （95% CI 80% - 88%）开始使用依那西普作为第一种生物制剂的患者在12个月后仍在使用该药，相比之下，47% （95% CI 35% - 60%）开始使用第二种生物制剂，51% （95% CI 26% - 76%）开始使用第三种生物制剂。因原发性无效而改用第二种药物的患者较少继续使用第二种药物（32%，95% CI 12%至53%）。依那西普失败后，阿达木单抗与英夫利昔单抗在非全身性JIA患者中的持续用药相似；anakinra优于第二种tnf -阻滞剂治疗系统性JIA。在开始治疗后的前12个月内，每个疗程和每种生物制剂的AE发生率具有可比性。结论切换到其他生物制剂是常见的，特别是对于全身性JIA患者。第二种（和第三种）药物不如第一种有效。医生选择第二种生物制剂主要取决于可获得性和JIA类别。
Objective To evaluate the effectiveness and safety of switching to a second or third biological agent in juvenile idiopathic arthritis (JIA) after etanercept failure.Methods The Arthritis and Biologicals in Children Register aims to include all Dutch JIA patients who have used biological agents. Data on the disease course were used to estimate drug survival with Kaplan-Meier and calculate adverse event (AE) rates.Results Of 307 biologically naive JIA patients who started etanercept, 80 (26%) switched to a second and 22 (7%) to a third biological agent. During 1030 patient-years of follow-up after the introduction of etanercept, 49 switches to adalimumab, 28 infliximab, 17 anakinra, four abatacept and four trial drugs were evaluated. 84% (95% CI 80% to 88%) of patients who started etanercept as a first biological agent were, after 12 months, still on the drug, compared with 47% (95% CI 35% to 60%) who started a second and 51% (95% CI 26% to 76%) who started a third biological agent. Patients who switched because of primary ineffectiveness continued the second agent less often (32%, 95% CI 12% to 53%). After etanercept failure, drug continuation of adalimumab was similar to infliximab for patients with non-systemic JIA; anakinra was superior to a second TNF-blocker for systemic JIA. AE rates within first 12 months after initiation were comparable for each course and each biological agent.Conclusions Switching to another biological agent is common, especially for systemic JIA patients. A second (and third) agent was less effective than the first. The choice of second biological agent by the physician mainly depends on availability and JIA category.