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 Foster at the annual meeting of the British Society for Rheumatology (BSR).
Dr. Foster, 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. Foster 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. Foster 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. Foster 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 Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.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. Foster 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. Foster 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. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.
Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.