Clinical Disease Manifestations Associated with Tumor Necrosis Factor inhibitor non-Response in Juvenile Spondyloarthritis.
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OBJECTIVE: To identify the clinical characteristics associated with initial TNFi nonresponse in JSpA patients METHODS: Retrospective analysis of JSpA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry between July 2015 and January 2019 and their response to first TNFi agent. JSpA population included enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Demographic and disease characteristics were compared at baseline visits prior to TNFi start and at time of initial TNFi non-response or the visit closest to 6 months following TNFi start for the responders. RESULTS: 286 patients met inclusion criteria; 168 were TNFi responders and 118 were TNFi nonresponders. Median time to TNFi non-response was 8.9 months (IQR: 5.3, 14.2 months). Median age at TNFi start was similar for non-responders (13.9y) and responders (13.8y, p=0.91). Non-responders were more likely to be female, 61.9% vs 48.2% (p=0.02), have higher BMI , 21.6 vs 19.2 (p=0.02) and longer symptom duration, 2.2y vs 1.4y, (p=0.04) compared to responders. Non-responders had more clinical sacroiliitis and higher patient global assessment (PtGA) at baseline visit compared to responders (p=0.004, p=0.007, respectively). The majority were secondary non-responders (N=113/118; 96%). Most patients switched to 2nd TNFi (60.2%) following initial TNFi non-response. CONCLUSION: Most nonresponders to TNFi had secondary nonresponse. JSpA patients who did not respond to initial TNFi were more likely to be female, have longer symptom duration prior to starting a TNFi, clinical sacroiliitis, and higher BMI and PtGA scores at baseline. Patients with these features should be monitored more carefully for treatment response.