title: Effectiveness and safety of TNF inhibitors in adults with juvenile idiopathic arthritis.
abstract: BACKGROUND
  Many children with juvenile idiopathic arthritis (JIA) continue to have active disease into adulthood. Adults with JIA are a heterogeneous group, and the effects of tumour necrosis factor inhibitor (TNFi) therapies are not well described. This analysis aims to describe treatment outcomes among patients with JIA starting TNFi for the first time in adulthood.
  
  
  METHODS
  Patients with arthritis onset <16 years starting their first TNFi therapy were identified from the British Society of Rheumatology Biologics Register. Disease activity outcomes (using 28-joint Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ)) are presented at 1 year after start of therapy according to disease pattern. Incidence rates (IR) of adverse events per 1000 person-years (pyrs) were calculated. Outcomes in patients with polyarticular JIA were compared with a cohort (weighted for age and gender) of patients with rheumatoid arthritis (RA).
  
  
  RESULTS
  In 443 adults with JIA starting a first TNFi, disease activity over 1 year improved across all measures. There were 58 first serious infections (IR 22.3/1000 pyrs); 4 cardiovascular events (IR 1.4/1000 pyrs); 11 uveitis events (IR 4.0/1000 pyrs) and 16 malignancies (IR 3.9/1000 pyrs). Compared with the weighted RA cohort, disease activity improvement was similar; malignancy rates were lower and uveitis rates much higher. While crude IR were similar, JIA patients had a lower risk of serious infection (HR 0.5 (95% CI 0.3 to 0.9)).
  
  
  CONCLUSIONS
  This is the largest study to describe disease activity and safety outcomes in adults with JIA receiving TNFi. Disease activity improved after 1 year in all disease patterns, suggesting TNFi is an effective therapy in this population.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester , Manchester , UK.
authors.forename: Lianne
authors.identifier: 0000-0003-0377-1575
authors.initials: L
authors.lastname: Kearsley-Fleet
authors.affiliation: Paediatric Rheumatology , Great North Children's Hospital , Newcastle upon Tyne , UK.
authors.forename: Flora
authors.initials: F
authors.lastname: McErlane
authors.affiliation: Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK; Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Foster
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester , Manchester , UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester , Manchester , UK.
authors.forename: Kath D
authors.initials: KD
authors.lastname: Watson
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
authors.forename: Deborah P M
authors.identifier: 0000-0002-8625-1200
authors.initials: DP
authors.lastname: Symmons
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
keywords: DMARDs (biologic); Juvenile Idiopathic Arthritis; Outcomes research; Rheumatoid Arthritis