Sistemik olmayan juvenil idiyopatik artrit tedavisinde biyolojik monoterapi ile biyolojik ve hastalık modifiye edici anti-romatizmal ilaç kombinasyonunun karşılaştırılması

Amaç Jüvenil idiyopatik artrit (JİA) tedavisinde konvansiyonel hastalık modifiye edici anti-romatizmal ilaçlar (cDMARD'lar) ile mono veya kombinasyon tedavisi olarak biyolojiklerin etkinliğini karşılaştırmak. Gereç ve Yöntem Ocak 2020- 2023 arasında kadar izlenen monoterapi olarak biyolojik ilaçlarla veya cDMARD kombinasyonuyla tedavi edilen hastaların tıbbi kayıtları retrospektif olarak incelendi. Demografik özellikler, klinik skorlar ve tedavi verileri değerlendirildi. Sonuçlar Tek başına veya JIA için bir cDMARD ile kombinasyon halinde etanersept, adalimumab veya tosilizumab alan 205 vaka dahil edildi. Grubun kadın erkek oranı hemen hemen eşitti. Oligoartiküler JİA'nın en yaygın alt tipiydi. Grubun büyük çoğunluğu (n=128, %62,4) biyolojik ilaçları monoterapi olarak alırken, geri kalan üçte birlik kısım (n=77, %37,6) biyolojik ve bir cDMARD kombinasyonu kullanmıştı. Grubun yaklaşık yarısı (%57,1) etanersept ile tedavi edilmişti ve jüvenil psoriatik artrit dışında tüm JİA alt tipleri arasında en sık kullanılan etanersept monoterapisiydi. Jüvenil psoriatik artritli çocukların çoğuna adalimumab kombinasyon tedavisi verildi. Hastalığın başlangıcında üveitli 8 hastanın hepsinde tek başına veya metotreksat ile kombinasyon halinde adalimumab tercih edildi. Takip sırasında üveit gelişenlerde adalimumab kombine (n=9) ve tosilizumab monoterapisi (n=4) en yaygın biyolojik ilaçlardı. Tartışma Etanersept, adalimumab ve tosilizumab JİA tedavisinde etkili ve güvenli biyolojik ilaçlardır. Maliyet etkin özellikleri göz önüne alındığında, biyolojik ilaçların zamanında kombine veya monoterapi olarak seçilmesi, JİA'nın erken ve geç sekellerini önlemede etkilidir.

Anahtar Kelimeler:

Juvenil idiyopatik artrit, biyolojik ilaç, hastalık modifiye edici anti-romatizmal ilaçlar

Comparison of biologic monotherapy versus biologic and disease-modifying anti-rheumatic drug combination in the treatment of non-systemic juvenile idiopathic arthritis

Purpose To explore the efficacy of biologics as mono- or combination therapy with conventional disease modifying anti-rheumatic drugs (cDMARDs) in the treatment of juvenile idiopathic arthritis (JIA). Material and Methods Medical records of patients with JIA followed-up from January 2020 to 2023 who were treated either with biologic drugs as monotherapy or with combination of cDMARD were reviewed retrospectively. Data of demographic features, clinical scores and treatments were assessed. Results Two hundred five cases received etanercept, adalimumab, or tocilizumab alone or in combination with a cDMARD for JIA were included. The male to female ratio of the cohort was almost equal. Oligoarticular was the most common subtype of JIA. Majority (n=128, 62.4%) of the group received biologic drugs as monotherapy, while the remaining third (n=77, 37.6%) used a combination of biologic and a cDMARD. Nearly half of the group (57.1%) were treated with etanercept and etanercept monotherapy was the most commonly used one among all JIA subtypes except juvenile psoriatic arthritis. Adalimumab combination therapy was prescribed in most of the children with juvenile psoriatic arthritis. Adalimumab, alone or in combination with methotrexate, was preferred for all 8 patients with uveitis at the onset of the disease. Adalimumab combined (n=9) and tocilizumab monotherapy (n=4) were the most common biologics in those who developed uveitis during follow-up. Conclusion Etanercept, adalimumab, or tocilizumab are effective and safe biologics in treatment of JIA. Considering their cost-effective properties, choosing biologic drugs timely as combined or monotherapy is effective in preventing early and late sequelae of JIA.

Keywords:

Juvenile idiopathic arthritis, biologic medications, disease-modifying anti-rheumatic drugs,

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