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11-07-2019 | Rheumatology | News | Article

Biologic therapy has paved the way for improved outcomes in JIA

medwireNews: The biologic treatment era has led to “remarkable prognostic improvement,” relative to the methotrexate era, for children with juvenile idiopathic arthritis (JIA), show data reported in Arthritis Research & Therapy.

The study revealed that the prevalence of inactive disease or low disease activity was significantly higher in the 269 patients diagnosed after 2000 (biologic era) than in the 239 diagnosed before 2000 (methotrexate era) when assessed at a cross-sectional visit a median 6.9 and 7.7 years after disease onset, respectively.

Using measures including active joint counts and the Wallace, JADAS10, and cJADAS10 criteria, Gabriella Giancane (Università degli Studi di Genova, Genoa, Italy) and colleagues found that among patients with oligoarthritis (up to four joints involved), the rates of inactive disease or low disease activity ranged from 52.6% to 66.2% in the biologic cohort and from 28.0% to 41.1% in the methotrexate cohort.

For those with polyarthritis (five or more joints involved), the corresponding ranges were 40.5–61.9% and 14.7–30.4%.

Furthermore “[t]he improvement in disease prognosis from the [methotrexate] to the biologic era was also underscored by the marked decrease over time in the frequency of articular and extraarticular damage,” Giancane et al remark.

Using the Juvenile Arthritis Damage Index (JADI), the team showed that the frequency of impairment of more than one JADI-Articular item was lower in the biologic era cohort than in the methotrexate era cohort for both oligoarthritis (11.0 vs 17.6%) and polyarthritis (21.8 vs 52.6%).

Similarly, the rates of involvement of more than one JADI-Extraarticular item were lower with biologic therapy than with methotrexate, at 16.2% versus 26.5% for patients with oligoarthritis and 13.5% versus 31.4% for those with polyarthritis.

On multivariable analysis, articular and extraarticular damage were a significant 2.68 and 2.52 times more likely to occur among patients diagnosed in the methotrexate era compared with those diagnosed in the biologic era.

The researchers note that the greatest reduction in impaired JADI items was observed for ocular damage in patients with oligoarthritis, which occurred in 12.7% of patients in the methotrexate cohort and just 0.7% of those in the biologic cohort.

By contrast, the rates of temporomandibular alterations and leg-length inequality did not fall following the introduction of biologic treatment.

Giancane and co-authors conclude that their study “provides evidence from standard clinical care of the remarkable prognostic improvement obtained with the recent therapeutic advance in JIA.”

However, they point out that “there is still a sizeable proportion of patients who do not achieve complete disease quiescence with contemporary therapies,” underscoring the continued “need for newer treatments and treatment strategies that have the ability to better control disease activity in the most resistant cases and to further reduce the development of disease damage.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Arthritis Res Ther 2019; 21: 168

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