Biologics with or without methotrexate in treatment of polyarticular juvenile idiopathic arthritis: effectiveness, safety and drug survival

Author:

Thiele Franz1ORCID,Klein Ariane12,Klotsche Jens3,Windschall Daniel45,Dressler Frank6,Kuemmerle-Deschner Jasmin7,Minden Kirsten8,Foeldvari Ivan9,Foell Dirk10,Mrusek Sonja11,Oommen Prasad Thomas12,Horneff Gerd12

Affiliation:

1. Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin , Sankt Augustin, Germany

2. Medical Faculty, University of Cologne , Cologne, Germany

3. Deutsches Rheuma-Forschungszentrum Berlin, Program Area Epidemiology , Berlin, Germany

4. Clinic for Paediatric and Adolescent Rheumatology, St Josef-Stift Sendenhorst, Northwest German Center for Rheumatology , Sendenhorst, Germany

5. University of Halle , Halle (Saale), Germany

6. Hannover Medical School, Children’s Hospital , Hannover, Germany

7. Division of Pediatric Rheumatology, Department of Pediatrics, University Hospital Tübingen , Tübingen, Germany

8. Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin, Germany

9. Hamburg Centrum for Paediatric and Adolescent Rheumatology , Hamburg, Germany

10. Clinic for Paediatric Rheumatology and Immunology, University Hospital Münster , Münster, Germany

11. Practice for Paediatric and Adolescent Rheumatology , Baden-Baden, Germany

12. Department of Pediatric Oncology, Hematology and Clinical Immunology, Division of Pediatric Rheumatology, Medical Faculty, University Hospital, Heinrich Heine University , Düsseldorf, Germany

Abstract

Abstract Objective To investigate the impact of additionally given MTX on biologic treatment of polyarticular JIA in terms of effectiveness, safety and drug survival. Methods Patients suffering from polyarticular JIA and treated with either monotherapy with a first biologic or a combination of a biologic and MTX were selected from the BIKER registry. The TNF-α inhibitors (TNFi) adalimumab, etanercept and golimumab and the IL-6 inhibitor tocilizumab were considered. Upon a non-randomized study design, we adjusted the different cohorts using propensity score matching to improve comparability. Results A total of 2148 patients entered the analysis, who were treated by either combination therapy (n = 1464) or monotherapy (n = 684). Disease activity declined significantly more in patients upon combination therapy than upon biologic monotherapy. Comparison of adjusted cohorts revealed that patients who received TNFi gained more benefit from additionally given MTX than patients treated with tocilizumab. Median survival time of therapy with biologics was significantly longer upon combination therapy (3.1 years) than with monotherapy (2.7 years), as demonstrated by a Kaplan–Meier analysis (log rank test: P = 0.002). The safety profile was moderately affected by additional MTX due to increased incidence of gastrointestinal and hepatic adverse events. Serious adverse events occurred at an equal rate of 3.6 events per 100 patient-years in both cohorts. Conclusion Additionally given MTX improves the effectiveness of biologic treatment in polyarticular JIA without seriously compromising treatment safety. Especially TNFi benefit from combination, while no improvement in outcome has been observed by combining tocilizumab with MTX.

Funder

BIKER

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3