Our discoveries

Our team of researchers are busy looking at all the information that has been collected in the studies to see what they can find out about the safety of biologic therapies, and also about how well they work for children and young people with JIA.

They have found out some interesting things about a lot of different areas.

Uveitis in children and young people with JIA treated with methotrexate and biologics

Uveitis is a condition in which the uvea (the coloured part of the eye) becomes inflamed. Up to one-in-four children and young people with JIA will develop uveitis.

There has been concern that one of the drugs used to treat JIA, etanercept, could increase this risk further.

Using data from the biologics registers, we showed that there was no increased risk of developing uveitis in those treated with etanercept when compared with methotrexate.

Children and young people with arthritis…what other diseases do they have?

Not much is known about what other diseases or medical conditions children and young people with arthritis (JIA) have, and how often they occur.

Large international registries capture detailed information on children and young people with JIA receiving different medications, including whether or not they have or later develop other diseases. This work aimed to combine data from three large registries to look at this issue in more detail.

We found that tuberculosis, an infection that clinicians worry about in immunosuppressed people, was extremely rare, which is reassuring.

We also showed the benefits of the chickenpox vaccine, demonstrating that it may be useful for those about to start immunomodulatory drugs, particularly as chickenpox in immunosuppressed children and young people can be a very serious disease.

In addition, this research has shown that collaborating internationally with other JIA biologic registers means that we have the potential to study rare safety effects in large populations.

Improved growth in JIA

It is known that children and young people with Juvenile Idiopathic Arthritis (JIA) can experience delayed or restricted growth. This piece of work looked at the influence of treatment with Enbrel (etanercept) on vertical growth (height) in the first two years of treatment.

We found that patients starting Enbrel were shorter than people who did not have JIA. However, the height of patients with JIA significantly improved after two years of treatment, suggesting that the control of inflammation can help with growth in some children.

Improved disease activity in JIA

Enbrel (etanercept) is a common treatment for children and young people with JIA. The researchers looked at how treatment with Enbrel affected disease activity (that is, how well the symptoms of JIA are controlled) in the first year of treatment.

The researchers found an improvement in the disease of children treated with Enbrel, with 38% of patients achieving an excellent response, and 48% achieving minimal disease activity after only 1 year.

Mortality (death) in JIA

It is known that the mortality rate in people with JIA is higher than the mortality rate of the general population. This research examined whether the risk of mortality changed depending on the subtype and severity of JIA.

The researchers looked at the mortality rates of children requiring treatment with methotrexate and/or biologic therapy with systemic JIA (a subtype of JIA that has very severe symptoms) and non-systemic JIA, compared with children who did not have JIA.

They found that, although death was a very rare outcome, mortality rates in this cohort of children with JIA were higher than in non-JIA individuals (particularly among children with systemic JIA). These highlight the severity of JIA as a disease, in particular systemic JIA.

Choice of biologic therapy for JIA

Our researchers were interested in looking at the features of patients starting biologic therapy for Juvenile Idiopathic Arthritis (JIA) for the very first time, and the patterns of which biologic drugs are prescribed by doctors in the UK.

They found that Enbrel (etanercept) is the most common biologic prescribed for JIA; however there has been a shift towards the use of other biologics. This is largely driven by the subtype of JIA. For example: patients with systemic JIA were almost exclusively prescribed Kineret (anakinra) or RoActremra (tocilizumab). In addition, patients with a history of an eye condition called chronic anterior uveitis were mostly prescribed Humira (adalimumab) or Remicade (infliximab).

If you stop biologic therapy for remission, are you likely to remain off treatment?

Doctors may consider reducing the dose or stopping biologic treatments in patients whose arthritis is well controlled, although it is unclear is this is an effective decision. Using the UK JIA Biologics Register, we have found that one-in-five (19%) patients on biologic therapy stopped for remission after approximately 2 years of treatment. Of those, just over half (55%) then restarted the same biologic therapy, usually after 4 months. Those less likely to need to re-start therapy were those who had started biologics earlier in their disease course. Those more likely to need to re-start biologic therapy were those who also had uveitis (which may have been the reason for needing to restart).

Read this scientific paper in full here

Biologic switching, and which biologic is best

There is a wide choice of biologic therapies available for children and young people with JIA. However, for some, treatment with their first biologic does not control their arthritis and they will have to try other biologics. We have found that of those on biologic therapy in our studies, approximately one-in-five went on to start a second biologic, and one-in-twenty received at least three biologics. We also found that in those where their first biologic (a TNF inhibitor) didn’t work, they responded equally well whether they started a second TNF inhibitor, or switched to a different class of biologic therapy. This indicates that if a biologic isn’t working for some patients, there are plenty of other options available.