{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:39:51Z","timestamp":1793147991291,"version":"4.5.0"},"reference-count":25,"publisher":"The Journal of Rheumatology","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Biologic medications have significantly improved disease control and outcomes of patients with juvenile idiopathic arthritis (JIA). Current treatment recommendations suggest escalating therapy, including changing biologics if needed, when inactive or low disease activity is not attained. The patterns and reasons for switching biologics in clinical practice in North America are not well described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the Childhood Arthritis and Rheumatology Research Alliance Registry and included individuals with JIA if they newly started a biologic after January 1, 2008, and had at least 12 months of subsequent observable time. Subjects with systemic JIA were excluded. We compared characteristics of switchers and nonswitchers using chi-square for categorical variables and Wilcoxon rank-sum test for continuous variables, and used linear regression for time analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the eligible children, 1361 with JIA in the registry started a biologic (94% tumor necrosis factor inhibitors [TNFi]). Median followup time was 30 months and 349 (26%) switched biologics. Among biologic switchers, ineffectiveness\/disease flare was the most common reason for switch (202, 58%). The most common documented switch was from etanercept to another TNFi (221, 63%). The median time to switch to a second biologic decreased substantially from 55.2 months in 2008 to 7.2 months in 2016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In a multicenter cohort of patients with JIA starting a biologic, one-quarter switched to a second biologic, and the time to switching decreased in recent years. Additional studies should evaluate the outcomes and optimal timing of switching and preferred sequence of biologic use.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.200437","type":"journal-article","created":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T16:20:22Z","timestamp":1600186822000},"page":"1322-1329","source":"Crossref","is-referenced-by-count":24,"title":["Biologic Switching Among Nonsystemic Juvenile Idiopathic Arthritis Patients: A Cohort Study in the Childhood Arthritis and Rheumatology Research Alliance Registry"],"prefix":"10.3899","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2216-970X","authenticated-orcid":false,"given":"Melissa L.","family":"Mannion","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenglong","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1831-1339","authenticated-orcid":false,"given":"Daniel B.","family":"Horton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Ringold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5451-1936","authenticated-orcid":false,"given":"Colleen K.","family":"Correll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Dennos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Beukelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2020,9,15]]},"reference":[{"key":"2022062114102975000_48.8.1322.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60363-8"},{"key":"2022062114102975000_48.8.1322.2","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.semarthrit.2017.05.007","article-title":"How common is remission in juvenile idiopathic arthritis: a systematic review","volume":"47","author":"Shoop-Worrall","year":"2017","journal-title":"Semin Arthritis Rheum"},{"key":"2022062114102975000_48.8.1322.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.13103"},{"key":"2022062114102975000_48.8.1322.4","unstructured":"U.S. Food & Drug Administration . FDA drug safety communication: update on tumor necrosis (TNF) blockers and risk for pediatric malignancy. [Internet. Accessed March 22, 2021.] Available from: www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-update-tumor-necrosis-factor-tnf-blockers-and-risk-pediatric"},{"key":"2022062114102975000_48.8.1322.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.39480","article-title":"2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis","volume":"68","author":"Singh","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"2022062114102975000_48.8.1322.6","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20460"},{"key":"2022062114102975000_48.8.1322.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213030"},{"key":"2022062114102975000_48.8.1322.8","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/acr.23870","article-title":"2019 American College of Rheumatology\/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis","volume":"71","author":"Ringold","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2022062114102975000_48.8.1322.9","doi-asserted-by":"publisher","DOI":"10.3310\/hta22440"},{"key":"2022062114102975000_48.8.1322.10","doi-asserted-by":"crossref","first-page":"102398","DOI":"10.1016\/j.autrev.2019.102398","article-title":"Failure of anti-TNF treatment in patients with rheumatoid arthritis: the pros and cons of the early use of alternative biological agents","volume":"18","author":"Rubbert-Roth","year":"2019","journal-title":"Autoimmun Rev"},{"key":"2022062114102975000_48.8.1322.11","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev374"},{"key":"2022062114102975000_48.8.1322.12","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.087130"},{"key":"2022062114102975000_48.8.1322.13","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-201060"},{"key":"2022062114102975000_48.8.1322.14","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1002\/phar.1856","article-title":"Use of tumor necrosis factor-alpha inhibitors in children and young adults with juvenile idiopathic arthritis or rheumatoid arthritis","volume":"36","author":"Lee","year":"2016","journal-title":"Pharmacotherapy"},{"key":"2022062114102975000_48.8.1322.15","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1080\/03007995.2018.1560221","article-title":"Patient attitudes about non-medical switching to biosimilars: results from an online patient survey in the United States","volume":"35","author":"Teeple","year":"2019","journal-title":"Curr Med Res Opin"},{"key":"2022062114102975000_48.8.1322.16","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12969-017-0160-6","article-title":"The new Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry: design, rationale, and characteristics of patients enrolled in the first 12 months","volume":"15","author":"Beukelman","year":"2017","journal-title":"Pediatr Rheumatol Online J"},{"key":"2022062114102975000_48.8.1322.17","unstructured":"U.S. Food & Drug Administration . 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