Gonzalez, MI

Merino, R

Murias, S

Remesal, A

Tarjuelo, I

English

PubMed

S Murias

A Remesal

L Latorre

M Gomez

R Merino

Crossref

Pediatric Rheumatology

Switching to an alternative biological agent in juvenile idiopathic arthritis (II)

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Switching to an alternative biological agent in
juvenile idiopathic arthritis (II)
S Murias, A Remesal, L Latorre, M Gomez, R Merino
From 18th Pediatric Rheumatology European Society (PReS) Congress
Bruges, Belgium. 14-18 September 2011
Background
Juvenile idiopathic arthritis (JIA) is a heterogeneous dis-
ease, and it’s associated with an increased use of various
biological agents in recent years.
Aim
Evaluate clinical response to current biological agent in
JIA patients.
Methods
This is a retrospective study of 109 JIA patients from a
tertiary centre (see poster 1). Variables included were:
current biological treatment (both the first agent used as
the second, third or fourth when it had been switched)
and duration of treatment (years with a new agent or
since reintroduction of an agent used before) plus physi-
cian visual analogue scale (ph-VAS), erythrocyte sedi-
mentation rate (ESR) and C-reactive protein (CRP) at
baseline and at the end of the study. Concomitant ther-
apy with methotrexate (MTX) was also recorded.
Results
Duration of treatment with the current biological agent
was 1.2 ± 1 (0.1- 4.9) median 0.8 years. This agent was
etanercept (ETA) in 58 cases, adalimumab (ADA) in 16,
tocilizumab (TCZ) in 11, anakinra (AK) in 9 and inflixi-
mab (IFX) in 2. Thirteen patients were off treatment
with biological agents, 12 due to inactive disease and
one because of inefficacy.
Concomitant treatment with MTX was observed in 8/
58 (14%) patients with ETA, 4/16 (25%) with ADA, 5/11
(46%) with TCZ, 1/2 (50%) with IFX and none with AK.
Table 1.
Conclusion
The results indicate that reintroduction of a previously
effective biological agent may be successful; besides,
switching to a second, third or even fourth biological
agent in those patients whose disease remains active,
can be effective as well.
Published: 14 September 2011
doi:10.1186/1546-0096-9-S1-P163
Cite this article as: Murias et al.: Switching to an alternative biological
agent in juvenile idiopathic arthritis (II). Pediatric Rheumatology 2011 9
(Suppl 1):P163.
Table 1 Analytical and clinical response to current biological agent
Ph-VAS ESR CRP
Initial* End* ۵ p Initial* End* ۵ p Initial* End* ۵ p
ETA 3.25 0.5 -6 0.00 28 12 -5 0.00 13.2 2.3 -5 0.00
ADA 2.42 0.4 -3 0.01 17 13 -1 0.26 5.58 1.2 -2 0.06
AK 5.36 0.00 -3 0.01 62 9 -2 0.02 69.5 2.9 -2 0.03
TCZ 6.45 0.86 -3 0.01 46 4 -3 0.01 95.6 0.6 -3 0.01
IFX 4.9 0.00 47 6 32.8 0.9
*Values are expressed as mean.
Murias et al. Pediatric Rheumatology 2011, 9(Suppl 1):P163
http://www.ped-rheum.com/content/9/S1/P163
© 2011 Murias et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


MI Gonzalez

I Tarjuelo

POSTER PRESENTATION Open Access
Switching to an alternative biological agent in
juvenile idiopathic arthritis (I)
A Remesal, S Murias, MI Gonzalez, I Tarjuelo, R Merino
From 18th Pediatric Rheumatology European Society (PReS) Congress
Bruges, Belgium. 14-18 September 2011
Background
Juvenile idiophatic arthritis (JIA) is a heterogeneous dis-
ease and it’s associated with an increased use of various
biological agents in recent years.
Aim
Describe changes in treatment with biological agents in
JIA patients.
Methods
This is a retrospective study of 109 JIA patients from a
tertiary centre. Variables included were: age, disease
duration, sex, antinuclear antibodies (ANA), HLA B27,
Rheumatoid Factor (RF), uveitis and data of systemic
AIJ. Current and previous biological agents, reasons for
change and adverse events were also recorded.
Results
The sample included 83 girls and 26 boys aged 10 ± 4.4
(2.4-19.6) with a disease duration of 5 ± 3.4 (0.1- 17)
years. The initial biological agent was etanercept (ETA)
in 87 cases, adalimumab (ADA) in 9, anakinra (AK) in
12 and infliximab (IFX) in 1. Twenty-eight patients
switched to a second biological agent, 7 to a third and 2
to a fourth. Switching was due to inefficacy since
adverse events were mild or moderate.
Current treatment with ETA was associated with ANA
positives (p=0,032), however ADA did so with uveitis
(p=0,000) and AK y TCZ with s-JIA (p=0,000). Table 1
Conclusion
1. Switching to a second biological agent was necessary
in 26% of patients. Only 6% of patients switched to a
third, and 2% to a fourth.
2. The results indicate that etanercept was chosen in
patients with ANA positives, adalimumab in cases with
uveitis and anakinra and tocilizumab in those with sys-
temic symptoms.
Table 1 Patient characteristics and biological agent treatment
Current treatment Sex M/F ANA (+) HLA B27 (+) RF (+) Uveitis Data of s-JIA Previous treatments
ETA n=58 11/47 19 (33%) 13 (22%) 2 (3%) 11 (19%) ADA n=1
ADA n=16 2/14 6 (38%) 3 (19%) 14 (88%) 1 (7%) ETA n=8
IFX n=1
AK n=9 5/4 1 (11%) 9 (100%) ETA n=2
TCZ n=11 3/8 1 (9%) 6 (55%) ETA n=7
IFX n=2
AK n=6
ADA n=3
IFX n=2 1/1 2 (100%) ETA n=2
Untreated* n=13 4/9 2 (15%) 2 (15%) 1 (8%) 1** (8%) ETA n=12
AK,TCZ n=1
* In 12 cases ETA was withdrawn due to inactive disease. **One child had episodes of macrophage activation syndrome, being with and without biological
agent.
Remesal et al. Pediatric Rheumatology 2011, 9(Suppl 1):P162
http://www.ped-rheum.com/content/9/S1/P162
© 2011 Remesal et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Published: 14 September 2011
doi:10.1186/1546-0096-9-S1-P162
Cite this article as: Remesal et al.: Switching to an alternative biological
agent in juvenile idiopathic arthritis (I). Pediatric Rheumatology 2011 9
(Suppl 1):P162.
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Remesal et al. Pediatric Rheumatology 2011, 9(Suppl 1):P162
http://www.ped-rheum.com/content/9/S1/P162
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Switching to an alternative biological agent in juvenile idiopathic arthritis (I)

Gonzalez MI

Murias S

Remesal A

Tarjuelo I

Merino R

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Switching to an alternative biological agent in juvenile idiopathic arthritis (I)

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