title: Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register.
abstract: BACKGROUND
  Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.
  
  
  OBJECTIVE
  To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA.
  
  
  METHODS
  The Arthritis and Biologics in Children register (multicentre prospective observational study) aimed to include all consecutive patients with JIA in the Netherlands who had started biological agents since 1999. Patients were divided according to year of introduction of first biological agent. Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years.
  
  
  RESULTS
  335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010. Etanercept remained the most often prescribed biological agent for non-systemic JIA; anakinra became first choice for systemic JIA. The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased. During these 12 years of observation, biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS (Juvenile Arthritis Disease Activity Score) disease activity. All baseline disease activity parameters were lowered in patients with non-systemic JIA. In systemic JIA, prescription patterns changed towards very early introduction of biological agents (median 0.4 years of disease duration) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates. These changes for both systemic and non-systemic JIA resulted in more patients with inactive disease after 3 and 15 months of treatment.
  
  
  CONCLUSIONS
  Biological agents are increasingly prescribed, earlier in the disease and in patients with JIA with lower disease activity. These changes are accompanied by better short-term disease outcomes.
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marieke H
authors.initials: MH
authors.lastname: Otten
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Anink
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Femke H M
authors.initials: FH
authors.lastname: Prince
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marinka
authors.initials: M
authors.lastname: Twilt
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Utrecht MC Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: S J
authors.initials: SJ
authors.lastname: Vastert
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Rebecca
authors.initials: R
authors.lastname: ten Cate
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, St Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Esther P A H
authors.initials: EP
authors.lastname: Hoppenreijs
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Wineke
authors.initials: W
authors.lastname: Armbrust
authors.affiliation: Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Simone L
authors.initials: SL
authors.lastname: Gorter
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Philomine A
authors.initials: PA
authors.lastname: van Pelt
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Sylvia S M
authors.initials: SS
authors.lastname: Kamphuis
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, St Lucas Andreas Hospital and Reade Institute, Amsterdam, The Netherlands.
authors.forename: Koert M
authors.initials: KM
authors.lastname: Dolman
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Utrecht MC Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Joost F
authors.initials: JF
authors.lastname: Swart
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Emma Children's Hospital, Amsterdam, The Netherlands.
authors.forename: J Merlijn
authors.initials: JM
authors.lastname: van den Berg
authors.affiliation: Department of Paediatrics, Hagaziekenhuis Juliana Children's Hospital, The Hague, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Koopman-Keemink
authors.affiliation: Department of Pediatrics/ Pediatric Rheumatology, Emma Children's Hospital/Academic Medical Centre and Reade Institute, Amsterdam, The Netherlands.
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Utrecht MC Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
authors.affiliation: Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000453:epidemiology*; D001685:Biological Factors / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D000068800:Etanercept; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors; D005938:Glucocorticoids; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept
keywords: Anti-TNF; DMARDs (biologic); Epidemiology; Juvenile Idiopathic Arthritis; Outcomes Research