title: Treatment choices of paediatric rheumatologists for juvenile idiopathic arthritis: etanercept or adalimumab?
abstract: OBJECTIVE
  To evaluate differences in baseline characteristics between etanercept- and adalimumab-treated JIA patients and to reveal factors that influence the choice between these TNF inhibitors, which are considered equally effective in the recent ACR recommendations for JIA treatment.
  
  
  METHODS
  Biologic-naïve JIA patients with active arthritis who started treatment with adalimumab or etanercept between March 2008 and December 2011 were selected from the Dutch Arthritis and Biologicals in Children register. Baseline characteristics were compared. Focus group interviews with paediatric rheumatologists were performed to evaluate factors determining treatment choices.
  
  
  RESULTS
  A total of 193 patients started treatment with etanercept and 21 with adalimumab. Adalimumab-treated patients had longer disease duration prior to the start of biologics (median 5.7 vs 2.0 years) and more often a history of uveitis (71% vs 4%). Etanercept-treated patients had more disability at baseline (median Childhood Health Assessment Questionnaire score 1.1 vs 0.4) and more active arthritis (median number of active joints 6 vs 4). The presence of uveitis was the most important factor directing the choice towards adalimumab. Factors specific for the paediatric population-such as painful adalimumab injections-as well as the physician's familiarity with the drug accounted for the preference for etanercept.
  
  
  CONCLUSIONS
  Although the two TNF inhibitors are considered equally effective, in daily practice etanercept is most often prescribed; adalimumab is mainly preferred when uveitis is present. In choosing the most suitable biologic treatment, paediatric rheumatologists take into account drug and patient factors, considering newly published data and cautiously implementing this into daily care.
authors.affiliation: Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. j.anink@erasmusmc.nl
authors.forename: Janneke
authors.initials: J
authors.lastname: Anink
authors.forename: Marieke H
authors.initials: MH
authors.lastname: Otten
authors.forename: Simone L
authors.initials: SL
authors.lastname: Gorter
authors.forename: Femke H M
authors.initials: FH
authors.lastname: Prince
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.forename: J Merlijn
authors.initials: JM
authors.lastname: van den Berg
authors.forename: Philomine A
authors.initials: PA
authors.lastname: van Pelt
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kamphuis
authors.forename: Danielle M C
authors.initials: DM
authors.lastname: Brinkman
authors.forename: Wijnand A A
authors.initials: WA
authors.lastname: Swen
authors.forename: Joost F
authors.initials: JF
authors.lastname: Swart
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
authors.forename: Koert M
authors.initials: KM
authors.lastname: Dolman
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Koopman-Keemink
authors.forename: Esther P A H
authors.initials: EP
authors.lastname: Hoppenreijs
authors.forename: Wineke
authors.initials: W
authors.lastname: Armbrust
authors.forename: Rebecca
authors.initials: R
authors.lastname: ten Cate
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D011307:Drug Prescriptions; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D010818:Practice Patterns, Physicians'; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068879:Adalimumab; D000068800:Etanercept
keywords: TNF-α inhibitors; decision making; juvenile idiopathic arthritis; qualitative research