Etanercept retreatment feasible in people with JIA
medwireNews: Etanercept is effective in the retreatment of patients with juvenile idiopathic arthritis (JIA) who have a disease flare after previously achieving inactive disease on the biologic (b)DMARD, research suggests.
Jens Klotsche (German Rheumatism Research Centre, Berlin) and colleagues analyzed data from 1724 patients with JIA who were enrolled in the BiKeR and JuMBO registries and had received at least one course of etanercept, 338 of whom had also received a second course and 54 a third.
The results “confirm the known effectiveness of [etanercept] in the treatment of JIA,” write the researchers, noting that 19.3% of patients discontinued treatment during the first course of etanercept after achieving inactive disease, defined as a score below 1 point on the physicians’ global assessment of disease activity or a cJADAS-10 of 1 point or lower, within a mean 2.5 years.
Of note, etanercept seemed “to be equally effective in re-treatment,” they add.
Among the 209 patients with available follow-up data after discontinuing their first course of etanercept, 77.0% of patients had a recurrence of active disease. Most (72.7%) of these patients were subsequently retreated with etanercept and within 12 months of restarting the agent, around 70% achieved inactive disease.
And nearly a fifth (19.7%) of the retreated patients were able to discontinue treatment after achieving inactive disease during an average follow-up of 2.8 years.
“On average, the patients responded well to reinitiation of [etanercept] treatment, as evidenced by the cJADAS-10 score, number of joints with active arthritis, and existence of [C-reactive protein] in the 18-month follow-up after restarting [etanercept],” emphasize Klotsche and co-researchers.
A similar proportion of patients taking their first, second, and third course of treatment discontinued due to ineffectiveness (19.4, 18.6, and 14.8%, respectively) and adverse events (6.2, 5.9, and 5.6%), most of whom switched to adalimumab or tocilizumab.
Multivariable analysis demonstrated that patients were significantly more likely to discontinue their first etanercept course after achieving remission if there was a shorter gap between disease onset and treatment initiation, at a mean of 46.0 and 60.8 months for people who did versus did not discontinue etanercept, and a hazard ratio (HR) of 0.91.
This finding “supports the concept of a window of opportunity in JIA, in that early initiation of treatment allows modulation of biologic processes, resulting in more favorable long-term disease trajectories,” write the researchers in Arthritis Research & Therapy.
Other factors significantly associated with achieving inactive disease and subsequent treatment discontinuation included younger age at start of treatment (HR=0.92), greater response to treatment within the first 6 months (HR=1.12), and persistent oligoarthritis (HR=1.89). Meanwhile, patients with rheumatoid factor-positive polyarthritis were significantly less likely to discontinue treatment due to inactive disease (HR=0.56).
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