Effectiveness of second-line biologics in juvenile idiopathic arthritis: the IIBIOJIA Study
Authors' conclusion
Our findings suggest that TNFi remains a viable and effective option as second-line bDMARDs in non-systemic JIA, regardless of the duration of prior TNFi exposure.
Study context
- Population
- Patients with non-systemic juvenile idiopathic arthritis (JIA) treated with at least two biological disease-modifying antirheumatic drugs (bDMARDs), at two paediatric rheumatology tertiary centrespatients recruited at two paediatric rheumatology tertiary centres
- Participants
- 127 patients
- Exposure
- TNFα inhibitors versus non-TNFi as second-line bDMARDs
- Outcome
- Calendar year of initiation of second-line bDMARD
Methodological detailslogistic generalised estimating equations (GEE) models with robust SEs, propensity scores, stratified into quintiles
- Logistic generalised estimating equations (GEE) models with robust SEs
- Propensity scores, stratified into quintiles
Main finding
As reported in the abstract
NON-TNFi
2021
median · IQR 2017–2023
TNFα inhibitors (TNFi)
2019
median · IQR 2013–2022
P = 0.03
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Achieving clinically inactive disease (CID) during the second course of bDMARD treatment | 4.19 (1.66–10.61) | P < 0.001 | |
| 0.050.21520Odds ratio (log scale) |
- Achieving clinically inactive disease (CID) during the second course of bDMARD treatment: multivariate GEE model adjusted for propensity score quintiles
Time on the first TNFi and achieving CID during the second TNFi
- OR 0.98, CI 0.79 to 1.21, p=0.83 (not significant)
- 0.98
Choice of second-line bDMARD
- Non-TNFi chosen as second-line bDMARD
- 25%
- Tocilizumab among non-TNFi (most common)
- 66%
- Choice influenced by the calendar year of prescription
Original publication
Effectiveness of second-line biologics in juvenile idiopathic arthritis: the IIBIOJIA Study. RMD Open. Published 27 October 2026. doi:10.
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