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Uptake and Use of Biologic Therapies in Paediatric Immune-Mediated Inflammatory Diseases: An Australian
Jun Ni Ho1, Jodie Hillen1,2, Natasha Nassar3,4,5
1Quality Use of Medicines and Pharmacy Research Centre, College of Health, Adelaide University, Adelaide, Australia.
Insights
Biologic medicine use in Australian children with immune-mediated inflammatory diseases (IMIDs) significantly increased from 2014 to 2020. Many children required extended treatment, with nearly one in five receiving multiple biologic medications.
Area of Science:
- Paediatric Rheumatology
- Immunology
- Pharmacovigilance
Background:
- Immune-mediated inflammatory diseases (IMIDs) impact children, necessitating effective treatments.
- Biologic medicines offer targeted therapies for IMIDs, but their real-world use in paediatrics requires characterization.
Purpose of the Study:
- To quantify the real-world utilization of biologic medicines in Australian paediatric patients diagnosed with IMIDs.
- To describe the demographic characteristics and treatment patterns of children initiating biologic therapy for IMIDs.
Main Methods:
- Analysis of Australian dispensing claims data for patients under 18 years from 2013 to 2020.
- Calculation of incidence and prevalence rates of biologic use, patient demographics, and the number of unique biologic medicines dispensed per child.
Main Results:
- Biologic medicine incidence and prevalence in children with IMIDs substantially increased between 2014 and 2020.
- Infliximab, adalimumab, and etanercept were the most commonly dispensed biologics, accounting for 80% of treatments.
- Children initiated on biologics were typically 14 years old, with inflammatory bowel diseases and inflammatory arthropathies being the primary indications; 18% received multiple unique biologic agents.
Conclusions:
- Paediatric patients with IMIDs often require prolonged biologic therapy, with a significant proportion receiving multiple agents over time.
- The findings highlight the need for ongoing post-market surveillance to monitor the safety and effectiveness of biologic treatments in children.
Purpose:
To quantify the real-world use and describe characteristics of paediatric patients initiating biologic medicines for immune-mediated inflammatory diseases (IMIDs).
Methods:
Dispensing claims for Australians aged less than 18 years were used to examine uptake and use trends of nine biologic medicines used for the treatment of IMIDs. A 15% random sample of the population was used for dispensings between 2013 and 2017, and a 30% sample for dispensings between 2017 and 2020. Incidence and prevalence rates of use per 1 000 000 population per year were calculated. Patient demographics at the time of first dispensing were determined and the number of unique medicines dispensed per person across the study period was calculated.
Results:
Incidence of use of biologics increased from 108 per million in 2014 to 192 per million in 2020, while prevalence increased from 352 per million to 877 per million over the same period. 1131 children were dispensed at least one biologic medicine; infliximab, adalimumab or etanercept accounted for 80% of dispensings. Mean age at first dispensing was 14 years (standard deviation: 3 years) and 51% were male. Of children initiated on biologics, 55% were first dispensed treatment for inflammatory bowel diseases and 29% for inflammatory arthropathies. While most children were dispensed only one unique biologic medicine, 15% were dispensed two, and 3% three or more over the study period.
Conclusions:
These results suggest that children remain on treatment for extended periods of time and nearly one in five children were dispensed multiple biologic medicines. Post-market studies should be prioritised to monitor safety among these groups.
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