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- Title
Pharmacological treatment patterns in patients with juvenile idiopathic arthritis in the Netherlands: a real-world data analysis.
- Authors
Kip, Michelle M A; Roock, Sytze de; Currie, Gillian; Marshall, Deborah A; Grazziotin, Luiza R; Twilt, Marinka; Yeung, Rae S M; Benseler, Susanne M; Vastert, Sebastiaan J; Wulffraat, Nico; Swart, Joost F; IJzerman, Maarten J
- Abstract
Objective To investigate medication prescription patterns among children with JIA, including duration, sequence and reasons for medication discontinuation. Methods This study is a single-centre, retrospective analysis of prospective data from the electronic medical records of JIA patients receiving systemic therapy aged 0–18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, JIA subtype) and medication prescriptions were extracted and analysed using descriptive statistics, Sankey diagrams and Kaplan–Meier survival methods. Results Over a median of 4.2 years follow-up, the 20 different medicines analysed were prescribed as monotherapy (n = 15) or combination therapy (n = 48 unique combinations) among 236 patients. In non-systemic JIA, synthetic DMARDs were prescribed to almost all patients (99.5%), and always included MTX. In contrast, 43.9% of non-systemic JIA patients received a biologic DMARD (mostly adalimumab or etanercept), ranging from 30.9% for oligoarticular persistent ANA-positive JIA, to 90.9% for polyarticular RF-positive JIA. Among systemic JIA, 91.7% received a biologic DMARD (always including anakinra). When analysing medication prescriptions according to their class, 32.6% involved combination therapy. In 56.8% of patients, subsequent treatment lines were initiated after unsuccessful first-line treatment, resulting in 68 unique sequences. Remission was the most common reason for DMARD discontinuation (44.7%), followed by adverse events (28.9%) and ineffectiveness (22.1%). Conclusion This paper reveals the complexity of pharmacological treatment in JIA, as indicated by: the variety of mono- and combination therapies prescribed, substantial variation in medication prescriptions between subtypes, most patients receiving two or more treatment lines, and the large number of unique treatment sequences.
- Subjects
NETHERLANDS; JUVENILE idiopathic arthritis; TREATMENT duration; RETROSPECTIVE studies; ANTIRHEUMATIC agents; DRUGS; RESEARCH funding; KAPLAN-Meier estimator; DESCRIPTIVE statistics; PHYSICIAN practice patterns; PATIENT compliance; TERMINATION of treatment; DISEASE remission
- Publication
Rheumatology, 2023, Vol 62, pSI170
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keac299