The necessity, efficacy and safety of biologics in juvenile idiopathic arthritis

OBJECTIVE: Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. Biologics have changed the faith of children with rheumatic diseases. The main objective of this study was to demonstrate the rate of usage, efficacy and safety of biologics in JIA subtypes.
METHODS: This retrospective observational cohort study was conducted between May 2010 and September 2017. All children with the diagnosis of JIA and children under a biological agent treatment were recorded into the local registry system. Age, gender, JIA subtype, medications used, the clinical status of the patient, tuberculosis screening results, and side effects observed under biologics were retrieved from the registry.
RESULTS: There were 405 patients with the diagnosis of JIA in the cohort. Biologics were used in 123 (30.3%) JIA patients. Subtype frequencies of JIA patients were as follows: persistent oligoarticular JIA (33.6%), enthesitis-related arthritis (29.2%), systemic JIA (13%), rheumatoid factor (RF)-negative polyarticular JIA (13%), extended oligoarticular JIA (4.2%), RF-positive polyarticular JIA (3.4%), psoriatic arthritis (1.8%) and unclassified arthritis (1.8%). The rate of biologic use was high in extended oligoarticular JIA (64.7% of the cases), RF-positive polyarticular JIA (57.1%), psoriatic arthritis (57.1%), RF-negative polyarticular JIA (41.5%), and in systemic JIA (39.6%). Enthesitis-related arthritis (27.1%), persistent oligoarticular JIA (17.6%) and unclassified arthritis (16.6%) patients were the cases that needed a biologic agent in the last order. At the last control, 78.9% of the cases were in remission, while 21.1% of them were active despite biologic treatment. Isoniazid prophylaxis was used in 30.8% of the patients. None of the patients developed active tuberculosis infection under prophylaxis. Adverse events were observed in 18.6% of patients under biologics as recurrent uncomplicated upper respiratory tract infections being the most common.
CONCLUSION: Biologics are safe and effective treatment options in children with JIA. Most of the JIA patients with polyarticular involvement require biologics earlier in the disease course. The risk of tuberculosis infection seems not to be increased after appropriate screening and prophylaxis.

Jüvenil idiyopatik artritte biyolojik ajan gereksinim, etkinlik ve güvenlik verileri

AMAÇ: Jüvenil idiyopatik artrit (JIA) çocuklarda kronik artritin en sýk nedenidir. Biyolojik ajanlar romatizmal hastalýðý olan çocuklarýn kaderini deðiþtirmiþtir. Çalýþmamýzýn amacý kliniðimizde JIA tanýsý olan ve biyolojik ajan kullanýlan hastalarda biyolojik ajanlarýn gereksinim sýklýðýný, etkinliðini ve güvenirliliðini saptamaktýr.
METOD: Bu prospektif gözlemsel çalýþma Mayýs 2010 ile Eylül 2017 tarihleri arasýnda gerçekleþtirilmiþtir. JIA tanýsý olup biyolojik kullanan hastalar lokal kayýt sistemine kaydedilmiþtir. Yaþ, cinsiyet, JIA alt tipi, kullanýlan ilaçlar, hastanýn son durumu, tüberküloz tarama sonuçlarý, ve biyolojik ajan altýnda gözlenen yan etkiler kaydedilmiþtir.
SONUÇLAR: Çalýþma döneminde toplam 405 hasta JIA tanýsý ile takip ve tedavi edilmekteydi ve 123 (%30.3) hastada biyolojik ajan kullanýlmýþtý. JIA alt tip analizi sonuçlarýna göre JIA kohortu persistan oligoartiküler JIA (%33.6), enthezit-iliþkili artrit (%29.2), sistemik JIA (%13), romatoid faktör (RF)-negatif poliartiküler JIA (%13), uzamýþ oligoartiküler JIA (%4.2), RF-pozitif poliartiküler JIA (%3.4), psoriatik artrit (%1.8) ve sýnýflandýrýlamayan artritten (%1.8) oluþmaktaydý. Biyolojik kullaným oraný uzamýþ oligoartiküler JIA (vakalarýn %64.7’sinde), RF-pozitif poliartiküler JIA (%57.1), psoriatik artrit (%57.1), RF-negatif poliartiküler JIA (%41.5) ve sistemik JIA da(%39.6) en yüksek iken, entezit-iliþkili artrit (%27.1), persistan oligoartiküler JIA (%17.6) ve sýnýflandýrýlamayan artritte (%16.6) biyolojik gereksinimi daha düþük idi. Son kontrolde hastalarýn %78.9’u remisyonda iken, %21.1’i aktif idi. Tüberkuloz taramasý sonucunda izoniyazid profilaksisi hastalarýn %30.8’ine verildi ve hiç bir hastada tüberküloz enfeksiyonu geliþmedi. Ýstenmeyen olay biyolojik ajan kullanan hastalarýn %18.6’sýnda gözlendi ve tekrarlayan üst solunum yolu enfeksiyonlarý en sýk idi
SONUÇ: JIA hastalarýnda biyolojik ajanlar etkili ve güvenli bir tedavi yöntemidir. Poliartiküler tutulumu olan hastalarda erken dönemlerde biyolojik ajan gereksinimi olmaktadýr. Uygun tarama ve profilaksi ile biyolojik kullanan hastalarda tüberküloz riski artmýþ deðildir. (NCI-2019-0139.R1)