Further, the time to initiation of a second biologic was more than 2.5 years after the initiation of a first TNF inhibitor in 25% of children. Outcomes may differ among children starting their second biologic in 2019, they note, including quicker cycling through biologics and, thereby, a reduction in time to treatment.
Dr. Lisette WA van Suijlekom-Smit of Erasmus Medical Center, Rotterdam, author of a related editorial, comments in an email to Reuters Health, “Information from the two combined UK registries reflects the treatment policy in daily practice in different time periods, and selected juvenile idiopathy arthritis categories. Today differs in many aspects from the early years.”
Although no differences were seen between a second TNF inhibitor and tocilizumab, she said, “the numbers are probably too small to detect [differences] when comparing two effective treatments.”
“The choice between all these new biologicals is more or less trial and error,” she says. “A great jump forward would be identifying the best target in the inflammatory cascade, as demonstrated for systemic juvenile idiopathic arthritis. The goal must be to make the best choice based on the different [disease] categories, or even better, on disease markers or characteristics of individual patients.”
“It is disappointing to realize that this evaluation of more recent data mirroring daily practice also clarifies that there is still too much treatment delay and many patients with missing disease activity variables—the objective tools to monitor disease activity in routine practice,” she notes.
“The management of juvenile idiopathic arthritis has undeniably changed, but further advances have to be made,” she says. “This will not be realized by introducing new biologics only; innovating the therapeutic approach with tight control and treating to target might be even more important.”
Reference
- Kearsley-Fleet L, Heaf E, Davies R, et al. Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: A national cohort study. Lancet Rheumatol. 2020 Apr 1; 2(4):PE217–E226.
- van Suijlekom-Smit L WA. Evaluating the past might enlighten the future. Lancet Rheumatol. 2020 Apr 1; 2(4):E197–E198.
