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07-12-2021 | Canakinumab | Adis Journal Club | Article

Rheumatology and Therapy

Reasons for Initiating Canakinumab among Patients with Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still’s Disease in the U.S. Real-World Settings

Authors: Peter Hur, Esther Yi, Raluca Ionescu-Ittu, Ameur M. Manceur, Kathleen G. Lomax, Jordan Cammarota, Jipan Xie, Raju Gautam, Priscila Nakasato, Navneet Sanghera, Nina Kim & Alexei A. Grom

Abstract

Introduction

The aim of this study was to understand the reasons for canakinumab initiation among patients with Still’s disease, including systemic juvenile idiopathic arthritis (SJIA) and adult-onset Still’s disease (AOSD), in US clinical practice.

Methods

Physicians retrospectively reviewed the medical charts of patients with Still’s disease (regardless of age at symptom onset) who were prescribed canakinumab from 2016 to 2018. Patients aged < 16 years at symptom onset were classified as having SJIA and those aged ≥ 16 years at symptom onset (calculated from case-record forms) were classified as having AOSD. Patient treatment history and physician reasons for canakinumab initiation were analyzed. Overall results were presented as SJIA/AOSD. Sensitivity analyses were performed for the robustness of the results.

Results

Forty-three physicians in the USA (rheumatologists/dermatologists/immunologists/allergists: 51.2/27.9/11.6/9.3%; subspecialty in adults/pediatrics: 67.4/32.6%) abstracted information for 72 patients with SJIA/AOSD (SJIA/AOSD/age unknown at symptom onset: 75.0/18.1/6.9%; mean age 19.4 years; children 61.1%; females 56.9%). Most patients (90.3%) received treatment directly preceding canakinumab initiation (etanercept 27.7%; anakinra 18.5%; adalimumab 16.9%); the respective treatment was discontinued due to lack of efficacy/effectiveness (43.1%) and availability of a new treatment (27.8%). Most common reasons for canakinumab initiation were physician perceived/experienced efficacy/effectiveness of canakinumab (77.8%; children/adults: 81.8/71.4%), lack-of-response to previous treatment (45.8%; children/adults: 36.4/60.7%), convenient administration/dosing (26.4%; children/adults: 29.5/21.4%) and ability to discontinue/spare steroids (25.0%; children/adults: 20.5/32.1%). The sensitivity analysis provided similar results.

Conclusions

In US clinical practice, physician perceived/experienced efficacy/effectiveness of canakinumab and lack-of-response to previous treatment were the primary reasons for canakinumab initiation among patients with SJIA/AOSD. Physician perceived/experienced efficacy/effectiveness and convenient administration/dosing of canakinumab were the most common reasons for canakinumab initiation among children, whereas lack-of-response to previous treatment and ability to discontinue/spare steroids being the most frequent reasons among adults.

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Key Summary Points

What is already known about this subject?

Canakinumab, a human monoclonal antibody, has demonstrated efficacy and safety in clinical trials in patients with systemic juvenile idiopathic arthritis (SJIA) and adult-onset Still’s disease (AOSD). 

Canakinumab has been approved in the USA and Europe for the treatment of active Still’s disease (including AOSD and SJIA in patients aged ≥ 2 years). However, there is limited research on prescribing patterns among physicians who initiate canakinumab in real-world settings.

What does this study add?

Review of medical charts of 72 patients with SJIA/AOSD in this real-world study from the USA revealed that physician perceived/experienced efficacy/effectiveness of canakinumab and patient’s lack-of-response to previous treatment were the most common reasons for canakinumab initiation in US clinical practice. 

The study also revealed that physician perceived/experienced efficacy/effectiveness and convenient administration/dosing of canakinumab were more frequent reasons for canakinumab initiation among children, whereas lack-of-response to previous treatment and ability to discontinue/spare steroids were more common reasons among adults.

How might this impact on clinical practice or future developments?

The study highlighted differences in the reasons for canakinumab initiation among children and adults, as well as by subspecialty of the treating physician, but further research is needed to better understand the explanations behind this prescription behavior. 

Since this study was not designed to follow-up the patient after canakinumab initiation, the exact reasons for change in initial/maintenance dosing from the approved label could not be ascertained and further research is suggested in this area.

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