title: Effectiveness and long-term retention of anti-tumour necrosis factor treatment in juvenile and adult patients with juvenile idiopathic arthritis: data from Reuma.pt.
abstract: OBJECTIVE
  Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases.
  
  
  METHODS
  We prospectively collected patient and disease characteristics from patients with JIA who started biological therapy. Adverse events were collected during the follow-up period. Predictors of response at 1 year and drug retention rates were assessed at 4 years of treatment for the first biologic agent.
  
  
  RESULTS
  A total of 812 JIA patients [65% females, mean age at JIA onset 6.9 years (s.d. 4.7)], 227 received biologic therapy; 205 patients (90.3%) were treated with an anti-TNF as the first biologic. All the parameters used to evaluate disease activity, namely number of active joints, ESR and Childhood HAQ/HAQ, decreased significantly at 6 months and 1 year of treatment. The mean reduction in Juvenile Disease Activity Score 10 (JADAS10) after 1 year of treatment was 10.4 (s.d. 7.4). According to the definition of improvement using the JADAS10 score, 83.3% respond to biologic therapy after 1 year. Fourteen patients discontinued biologic therapies due to adverse events. Retention rates were 92.9% at 1 year, 85.5% at 2 years, 78.4% at 3 years and 68.1% at 4 years of treatment. Among all JIA subtypes, only concomitant therapy with corticosteroids was found to be univariately associated with withdrawal of biologic treatment (P = 0.016).
  
  
  CONCLUSIONS
  Biologic therapies seem effective and safe in patients with JIA. In addition, the retention rates for the first biologic agent are high throughout 4 years.
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, afilipamourao@gmail.com.
authors.forename: Ana F
authors.initials: AF
authors.lastname: Mourão
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Rheumatology Department, Hospital Garcia de Orta, Almada.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Santos
authors.affiliation: Instituto Português de Reumatologia.
authors.forename: José A
authors.initials: JA
authors.lastname: Melo Gomes
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Portuguese Society of Rheumatology.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Martins
authors.affiliation: Portuguese Society of Rheumatology.
authors.forename: Sílvia C
authors.initials: SC
authors.lastname: Mendonça
authors.affiliation: Rheumatology Department, Lisbon Academic Medical Center, Lisbon.
authors.forename: Filipa
authors.initials: F
authors.lastname: Oliveira Ramos
authors.affiliation: Instituto Português de Reumatologia.
authors.forename: Susana
authors.initials: S
authors.lastname: Fernandes
authors.affiliation: Pediatrics Department, Centro Universitário Hospitalar de Coimbra, Coimbra.
authors.forename: Manuel
authors.initials: M
authors.lastname: Salgado
authors.affiliation: Pediatrics Department, Unidade de Imunologia Clínica, Centro Hospitalar do Porto, Porto.
authors.forename: Margarida
authors.initials: M
authors.lastname: Guedes
authors.affiliation: Pediatrics Department, Centro Hospitalar do Médio-Ave, Famalicão.
authors.forename: Sónia
authors.initials: S
authors.lastname: Carvalho
authors.affiliation: Rheumatology Department, ULSAM - Hospital Conde de Bertiandos, Ponte de Lima.
authors.forename: José A
authors.initials: JA
authors.lastname: Costa
authors.affiliation: Rheumatology Department, Hospital de São João, Faculdade de Medicina da Universidade do Porto, Porto.
authors.forename: Iva
authors.initials: I
authors.lastname: Brito
authors.affiliation: Rheumatology Department, Centro Universitário Hospitalar de Coimbra, Coimbra.
authors.forename: Cátia
authors.initials: C
authors.lastname: Duarte
authors.affiliation: Rheumatology Department, Hospital do Divino Espírito Santo, S. Miguel, Açores.
authors.forename: Carolina
authors.initials: C
authors.lastname: Furtado
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular.
authors.forename: Ana
authors.initials: A
authors.lastname: Lopes
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Rheumatology Department, Hospital de Santo Espírito, Angra do Heroísmo, Terceira and.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Rheumatology Department, Centro Hospitalar do Algarve, Faro, Portugal.
authors.forename: Graça
authors.initials: G
authors.lastname: Sequeira
authors.affiliation: Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon.
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Branco
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Rheumatology Department, Lisbon Academic Medical Center, Lisbon.
authors.forename: João E
authors.initials: JE
authors.lastname: Fonseca
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Rheumatology Department, Lisbon Academic Medical Center, Lisbon.
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D001799:Blood Sedimentation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: biological treatment; efficacy; juvenile idiopathic arthritis; safety