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AB0872 Switching of Biologic Treatment in One Paediatric Rheumatology Centre. Retrospective Review

Background The treatment of children with rheumatic and musculoskeletal diseases (RMD) have changed significantly with biologic treatment. Objectives To look at reasons for switching from one biologic to another. Methods Patients with confirmed RMD identified in our centre using The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), from 1st January 2011 to 31st December 2015. Retrospective review of electronic records and paper case notes of patients presented to the centre reviewed using pre-specified Clinical Research Form (CRF). Results We identified 181 paediatric patients on continuous follow up. The distribution as follows; juvenile Idiopathic Arthritis (JIA) 78, Systemic Lupus (JSLE) 19, Juvenile Scleroderma (Scl) 5, vasculitis 7, Juvenile Dermatomyositis (JDM) 6, Familial Mediterranean Fever (FMF) 9, Macrophage Activation Syndrome (MAS) 3 and Uveitis only in 2. Other diagnoses of non-inflammatory nature 52 including juvenile osteoporosis, mechanical pain syndromes and vitamin D deficiency. The total number of patients on biological therapy is 35 patients including 33 JIA and 2 JSLE. The number of patients still on the same biologic agent is 25. The following are the biologics with numbers of patients still on the same therapy (25): Etanercept 7 (JIA), Infliximab 3 (JIA), Adalimumab 1 (Uveitis), Abatacept 1 (JIA), Tocilizumab 7 (JIA), Anakina 4 (JIA 3, FMF 1), Rituximab 2 (JSLE). The number of patients who switched their treatment to a second or third agent is 10. The reason for switching biological treatment was lack of efficacy in 7 out of the 10 patients and side effects in the other 3 patients (table 1). Average follow up on current treatment of 36.6 months (range 0.5 to 81 months).Table 1 Case Number Diagnosis 1st biologic 2nd Biologic 3rd Biologic Reason for switching 1 Oligo JIA + Uveitis Adalimumab Infliximab Persistent eye inflammation 2 Extended JIA Etanercept Tocilizumab Persistent joint inflammation 3 Polyarticular JIA Adalimumab Abatacept Persistent joint inflammation 4 Polyarticular JIA Adalimumab Tocilizumab Abatacept Persistent joint inflammation in 2nd and 3rd 5 Polyarticular JIA Etanercept Adalimumab Uveitis with etanercept 6 Extended Oligo JIA Abatacept Tocilizumab Persistent inflammation 7 Systemic JIA Tocilizumab Canakinumab Anakinra Persistent inflammation with 1st biologic MAS twice on Canakinumab 8 Enthesitis Related JIA Etanercept Adalimumab Uveitis on Etanercept 9 Poly JIA Adalimumab Tocilizumab Persistent joint inflammation 10 Systemic JIA Etanercept Tocilizumab Persistent inflammation Conclusions The percentage of patients who switched biological treatment is 28.6% although numbers are small. Reasons for switching biologic treatment in our experience in children with RMD is: -lack of efficacy with persistent inflammation in 7 out of 10. -Side effects of treatment in 3 out of the 10 (Uveitis while on etanercept (2) and one developed MAS twice on canakinumab. Acknowledgement To all the children and their families for allowing us to use their data. Disclosure of Interest None declared