The association between ethnicity, socioeconomic position and outcomes following initiation of TNF inhibitors in Juvenile Idiopathic Arthritis: Results from the UK JIA Biologics Register
Richard P Beesley, Eileen Baildam, Michael W Beresford, Sharon Douglas, Taunton R Southwood, , Devesh Mewar, Helen Marzo-Ortego, Flora McErlane, Ben Parker, Elizabeth MacPhie, Srinivasan Venkatachalam, Sharmin Nizam, Ian Gaywood, Rachel Tattersall, Niki Erb, Abbas Ismail, Coziana Ciurtin, Debajit Sen, Elizabeth Murphy, Easwaradhas Gladston-Chelliah, Mark Quinn, Kate Armon, Michael Beresford, Liza McCann, Gillan Bask, Lorna Walding, Susan Marchant, Nagui Gendi, Eslam Al-Abadi, Charlene Bass-Woodcock, Charlene Bass Woodcock, Athimalaipet Ramanan, Louise Walker, John Bourne, Bridget Oates, Vicky Ohlsson, David James, Nick Wilkinson, Kathy Bailey, Flora McErlane, Ovgu KulCinar, Gill Pountain, Mitra, Mark Wood, Arani Sridhar, Karen Davies, Kate Armon, Rachel Jeffery, Imogen Norton, Kathy Bailey, Afraa Al-Sabbagh, Fouz Rahmeh, Joanne Borbone, Alison Leak, Rangaraj Satyapal, Kishore Warrier, Gulshan Malik, Richard Bowker, Nigel Osborne, Catriona Anderson, Jo Walsh, Alice Chieng, Richard Brough, Jonathon Packham, Alex Tabor, Daniel Hawley, Daniel Hawley, Alice Leahy, Rajesh Rawlani, Jon Packham, Jo Walsh, Rosemary Waller, Karen Davies, Willam Coles, Jeremy Camilleri, Lisa Bray, Kimme L Hyrich, Jenny H Humphreys, Lianne Kearsley-FleetAbstract
Objectives
Health outcomes in children and young people are known to vary by ethnicity and socioeconomic position. In juvenile idiopathic arthritis (JIA), it is unclear whether this relates to differential changes following one of the most common treatments, TNF-inhibitors (TNFi). This study investigated these factors, disease activity and treatment persistence following initial TNFi therapy in patients with JIA in the UK.
Methods
Patients with non-systemic JIA in the UK JIA Biologic Register starting their first TNFi biologic were included. Outcomes included change in disease activity between start of TNFi and 6 months, measured by JADAS-71.
Multivariable linear regression was used to assess the association between ethnicity or socioeconomic position and change in JADAS. Treatment persistence was analysed using Kaplan-Meier estimates. Cox proportional hazards models compared TNFi drug persistence by ethnic group and by socioeconomic position.
Results
A total of 1,641 patients were included; 67% female, 90% White ethnic group (6% Asian, 2% Black, 2% Mixed), 25% in the most deprived socioeconomic group. JADAS-71 improved for all ethnic and socioeconomic groups by 6 months, with no difference in improvement by group.
The proportion of patients remaining on TNFi at 12 months (67%) and the likelihood of stopping was similar between all ethnic and socioeconomic groups.
Conclusion
Outcomes following TNFi initiation are similar between ethnic and socioeconomic groups. Based on the results of this study, ethnicity and socioeconomic position do not appear to be associated with differential change in disease activity, and there is no evidence that the effects of socioeconomic position are moderated by ethnicity or vice versa.