Beukelman T, Lougee A, Matsouaka RA, et al. - Contemporary patterns of etanercept (ETN) use in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry are described. Largely American College of Rheumatology guidelines are followed in treatment.

• Categorization of patterns of ETN and methotrexate (MTX) use among patients with pediatric onset rheumatic diseases, including JIA, was done as follows: combination therapy (ETN and MTX started concurrently), step-up therapy (MTX started first and ETN added later), switchers (MTX started and then stopped when or before ETN started), MTX add-on (ETN started first and MTX added later), and ETN only (no MTX use).

• Among 2,032 patients with JIA who met the inclusion criteria, most (66.9%) received treatment with a non-biologic disease modifying anti-rheumatic drug (DMARD), primarily MTX, prior to ETN.

• Significant variability was evident in patterns of MTX use prior to initiating ETN.

• The most common approach was step-up therapy.

• Continuous treatment with a non-biologic DMARD 3 months or more after ETN initiation was recorded only in 34.0% of persistent oligoarticular JIA patients.

• MTX initiation pattern seemed influencing ETN persistence among spondyloarthritis patients (enthesitis related arthritis and psoriatic JIA), with those initiating combination therapy (68.9%) and switchers/ETN only (73.3%) patients exhibiting higher ETN persistence rates compared with those on step-up (65.4%) and MTX add-on (51.1%) therapy.