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Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study

researchsnappy by researchsnappy
March 10, 2020
in Healthcare Research
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Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study
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Active joint count (71 joints) Baseline 5·3 (0·5) 5·0 (0·9) 0·77 6 months 2·3 (0·3) 2·7 (0·8) 0·61 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−2·9 (0·5)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−2·2 (1·0)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) −0·5 (−1·8 to 0·9) 1 (ref) 0·51 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

−0·6 (−2·9 to 1·8) 1 (ref) 0·64 Limited joint count (71 joints) Baseline 4·5 (0·5) 3·8 (0·8) 0·47 6 months 3·3 (0·5) 2·4 (0·9) 0·43 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−1·2 (0·6)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−1·4 (1·2)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) 0·7 (−1·6 to 2·9) 1 (ref) 0·55 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

0·2 (−2·6 to 3·0) 1 (ref) 0·89 Physician’s global assessment of disease activity (VAS 0–10 cm) Baseline 3·1 (0·2) 3·8 (0·4) 0·11 6 months 1·8 (0·2) 2·5 (0·4) 0·081 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−1·4 (0·2)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−1·3 (0·5)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) −0·6 (−1·4 to 0·2) 1 (ref) 0·17 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

−0·7 (−1·7 to 0·3) 1 (ref) 0·16 PtGE (VAS 0–10 cm) Baseline 4·1 (0·2) 4·6 (0·5) 0·43 6 months 2·9 (0·2) 3·8 (0·6) 0·089 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−1·2 (0·3)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−0·7 (0·6)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) −0·8 (−1·8 to 0·3) 1 (ref) 0·14 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

−0·8 (−2·1 to 0·4) 1 (ref) 0·19 CHAQ score (range 0–3) Baseline 1·03 (0·07) 1·10 (0·13) 0·63 6 months 0·89 (0·07) 1·02 (0·15) 0·40 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−0·14 (0·06)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−0·08 (0·14)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) −0·1 (−0·3 to 0·2) 1 (ref) 0·52 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

−0·04 (−0·3 to 0·2) 1 (ref) 0·80 Pain (VAS 0–10) Baseline 4·6 (0·3) 4·5 (0·5) 0·89 6 months 3·6 (0·2) 3·9 (0·5) 0·58 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−1·0 (0·3)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−0·6 (0·6)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) −0·3 (−1·4 to 0·7) 1 (ref) 0·51 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

−0·4 (−1·7 to 0·8) 1 (ref) 0·50 Erythrocyte sedimentation rate (mm/h) Baseline 18 (1·7) 16 (3·5) 0·73 6 months 12 (1·1) 9 (2·4) 0·21 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−5·4 (1·6)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−7·2 (3·7)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) 2·7 (−1·8 to 7·2) 1 (ref) 0·24 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

2·4 (−4·8 to 9·7) 1 (ref) 0·51 C-reactive protein concentration (mg/L) Baseline 14 (2·2) 6·9 (2·2) 0·10 6 months 7·6 (1·3) 4·2 (1·6) 0·20 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−6·5 (2·0)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−2·6 (2·7)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) 1·2 (−3·2 to 5·7) 1 (ref) 0·58 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

0·9 (−6·6 to 8·4) 1 (ref) 0·82 JADAS-71 score Baseline 13 (0·8) 14 (1·4) 0·68 6 months 7·3 (0·6) 9·4 (1·3) 0·10 Difference

*

* From time of initiation of second biologic to 6 months thereafter, accounting for baseline values.

−5·9 (0·8)

†

† Significant change in variable between baseline and 6 months (p<0·05).

−4·5 (1·6)

†

† Significant change in variable between baseline and 6 months (p<0·05).

.. Unadjusted β coefficient (95% CI) −1·9 (−4·3 to 0·5) 1 (ref) 0·12 Propensity quintile adjusted β coefficient (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

−2·2 (−5·8 to 1·4) 1 (ref) 0·23 Proportion of patients who achieved ACR Pedi 90 (%)

§

§ For ACR Pedi 90 and minimal disease activity outcomes, patients who stopped biologic therapy before the 6-month outcome measurements were completed were classified as non-responders and those who stopped because they had achieved remission were classified as responders.

6 months (95% CI) 24% (17 to 31) 13% (2 to 25) .. Unadjusted OR (95% CI) 2·1 (0·7 to 6·2) 1 (ref) 0·17 Propensity quintile adjusted OR (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

2·5 (0·8 to 7·9) 1 (ref) 0·11 Proportion of patients who achieved minimal disease activity (%)

§

§ For ACR Pedi 90 and minimal disease activity outcomes, patients who stopped biologic therapy before the 6-month outcome measurements were completed were classified as non-responders and those who stopped because they had achieved remission were classified as responders.

6 months (95% CI) 31% (23 to 38) 23% (9 to 37) .. Unadjusted OR (95% CI) 1·5 (0·7 to 3·5) 1 (ref) 0·31 Propensity quintile adjusted OR (95% CI)

‡

‡ Propensity quintile adjusted for the following variables at the time of initiation of second biologic: second biologic start year (before 2010, 2010–2015, or 2016–2018), time since initiation of first biologic, gender, ILAR category, age, disease duration, concomitant methotrexate, concomitant steroids, active joint count, limited joint count, physician’s global assessment of overall disease activity, patient (or parent) evaluation of overall wellbeing, CHAQ, pain, erythrocyte sedimentation rate, C-reactive protein concentration, and JADAS-71 score.

1·6 (0·6 to 3·8) 1 (ref) 0·33
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