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Increased incidence of inflammatory bowel disease on etanercept in juvenile idiopathic arthritis regardless of concomitant methotrexate use

Permanent link
https://hdl.handle.net/10037/24359
DOI
https://doi.org/10.1093/rheumatology/keab678
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Date
2021-09-11
Type
Journal article
Tidsskriftartikkel
Peer reviewed

Author
van Straalen, Joeri W.; Krol, Roline; Giancane, Gabriella; Panaviene, Violeta; Ailioaie, Laura Marinela; Dolezalova, Pavla; Cattalini, Marco; Susic, Gordana; Sztajnbok, Flavio; Maritsi, Despoina; Constantin, Tamas; Sawhney, Sujata; Rygg, Marite; Oliveira, Sheila K.; Nordal, Ellen Berit; Saad-Magalhaes, C; Rubio-Perez, Nadina; Jelusic, Marija; de Roock, Sytze; Wulffraat, Nico; Ruperto, Nicolino; Swart, Joost Frans; International Trials Org, Paediatric Rheumatology
Abstract
Objectives: To describe risk factors for inflammatory bowel disease (IBD) development in a cohort of children with juvenile idiopathic arthritis (JIA).

Methods: JIA patients who developed IBD were identified from the international Pharmachild register. Characteristics were compared between IBD and non-IBD patients and predictors of IBD were determined using multivariable logistic regression analysis. Incidence rates of IBD events on different disease-modifying anti-rheumatic drugs (DMARDs) were calculated, differences between therapies were expressed as relative risks (RR).

Results: Out of 8,942 patients, 48 (0.05%) developed IBD. These were more often male (47.9% vs 32.0%) and HLA-B27 positive (38.2% vs 21.0%) and older at JIA onset (median 8.94 vs 5.33 years) than patients without IBD development. They also had more often a family history of autoimmune disease (42.6% vs 24.4%) and enthesitis-related arthritis (ERA) (39.6% vs 10.8%). The strongest predictors of IBD on multivariable analysis were ERA (OR: 3.68, 95% CI: 1.41-9.40) and a family history of autoimmune disease (OR: 2.27, 95% CI: 1.12-4.54). Compared with methotrexate monotherapy, the incidence of IBD on etanercept monotherapy (RR: 7.69, 95% CI: 1.99-29.74), etanercept with methotrexate (RR: 5.70, 95% CI: 1.42-22.77) and infliximab (RR: 7.61, 95% CI: 1.27-45.57) therapy was significantly higher. Incidence on adalimumab was not significantly different (RR: 1.45, 95% CI: 0.15-13.89).

Conclusion: IBD in JIA was associated with ERA and a family history of autoimmune disease. An increased IBD incidence was observed for etanercept therapy regardless of concomitant methotrexate use.

Publisher
Oxford University Press
Citation
van Straalen JW, Krol R, Giancane G, Panaviene V, Ailioaie, Dolezalova P, Cattalini M, Susic G, Sztajnbok F, Maritsi D, Constantin T, Sawhney S, Rygg M, Oliveira SK, Nordal E, Saad-Magalhaes C, Rubio-Perez N, Jelusic M, de Roock S, Wulffraat N, Ruperto N, Swart JF, International Trials Org. Increased incidence of inflammatory bowel disease on etanercept in juvenile idiopathic arthritis regardless of concomitant methotrexate use. Rheumatology. 2021
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