Adults With JIA Fail to Get Needed Biologics

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Adolescent Medicine: Adults With JIA Fail to Get Needed Biologics

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BRIGHTON, ENGLAND - The use of biologic agents in adults with juvenile

idiopathic arthritis needs guidance, a situation that the British Society

for Rheumatology and British Society for Pediatric and Adolescent

Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics

in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen

at the annual meeting of the British Society for Rheumatology (BSR).

Dr. , professor of pediatric rheumatology at Newcastle University,

England, commented that the current use of biologics in adult JIA patients

is based on a paucity of data, with only one biologic agent, etanercept,

currently approved for use by the National Institute for Health and Clinical

Excellence (NICE).

" Clearly adults with JIA are receiving biologic treatments, and data so far,

albeit from registries, are actually quite encouraging of a good response, "

Dr. said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495

patients registered in adulthood one third had disease onset reported before

the age of 16 years, with one fifth (21%) officially diagnosed with JIA.

Importantly, Dr. noted that these data showed that disease flares

were still possible after many years of remission, at a median of 20 years

for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of

biologic drugs to treat inflammatory diseases in the United Kingdom. In the

report, the estimated need for biologic agents in adults who had JIA was

just 15% - a likely underestimate, Dr. suggested.

" Undoubtedly, the proportion of patients with JIA who reach adulthood and

who will require either ongoing treatment with a biologic agent or de novo

treatment for disease flares is going to increase, " she observed.

However, despite the need for continued or first-time biologic use in adults

with JIA, these patients often fall into a gap between pediatric and adult

care. Anecdotal evidence suggests that funding for treatment might be

withdrawn when a JIA patient reaches 18 years of age and that if continued

treatment is needed, a new application for funding must be made to adult

services.

With this in mind, better links between juvenile and adult rheumatology

services are sorely needed. The new BSR/British Society for Paediatric and

Adolescent Rheumatology (BSPAR) statement will note that patients

transferring to adult care are likely to need continued treatment with a

biologic agent and that treatment should not be stopped solely on the basis

of age. The process of ongoing funding needs to be in place before transfer,

Dr. said.

The BSR/BSPAR statement will also comment on eligibility for biologic

agents, noting that appropriate tools for adults with JIA are specifically

needed. Currently, the only guidance on use of biologics in JIA is for

etanercept in the pediatric population and, clearly, adults with JIA are a

distinct patient population.

" The management of JIA has changed dramatically in the last decade, and it's

going to change again towards a more individualized approach in the future, "

Dr. said. She added that the choice of biologic is very much down to

a variety of factors - clinician's experience, patient choice, and clinical

scenario, but that there is an obvious need for consensus on which agent or

agents to use.

There is also a need for improved surveillance, and existing juvenile and

adult biologics registries provide important information about the long-term

safety of these agents, and these need to be linked up, both in the United

Kingdom and in Europe.

" Optimal care requires adult rheumatologists who have experience or training

in adolescent rheumatology, " Dr. further advised. Adults with JIA

have multiple and often complex issues, she added, and these need to be

addressed by appropriately trained staff.

Dr. has received honoraria from Abbott, Pfizer, and Schering-Plough.