JIA patients benefit from early aggressive combination treatment
medwireNews: Timing of biologic DMARD use is important in the treatment of children with newly diagnosed polyarticular course juvenile idiopathic arthritis (pcJIA), with early use significantly more effective in reducing disease activity than delayed use, research shows.
The findings are based on an analysis of real-world data for 465 DMARD-naïve children and adolescents aged 1–19 years with newly diagnosed pcJIA.
Of these, 135 were treated according to an early aggressive treatment strategy whereby they received both a conventional synthetic (cs)DMARD and a biologic prescription within 2 months of diagnosis. The remaining 330 were treated according to a conservative strategy that involved initial treatment with a csDMARD and no biologics until at least 3 months later.
Bin Huang and colleagues, from Cincinnati Children's Hospital Medical Center in Ohio, USA, report that patients on early aggressive treatment had significantly more active disease at baseline than those on conservative treatment (mean cJADAS 16.08 vs 12.39 points), but there was no significant difference between the two groups at either 6 months (6.47 vs 6.91 points) or 12 months (5.45 vs 5.25 points).
However, when the researchers conducted causal inference analyses that balanced out the treatment selection bias, they found that, if all patients had gone through early aggressive treatment, cJADAS would be a significant 2.17 points lower on average at 6 months than if they had all gone through conservative treatment, with the treatment benefit sustained up to 12 months.
The same analysis showed that introducing a biologic agent after 6 months of treatment with a csDMARD would result in a nonsignificant additional reduction in cJADAS of 0.39 points compared with continuing with the csDMARD alone.
In line with these findings, the Pediatric Quality of Life Inventory (PedsQL) generic total score was significantly worse in the early aggressive treatment group at baseline relative to the conservative treatment group, but scores improved in both groups over time and did not differ significantly between the two treatments at either 6 or 12 months.
In this case, the causal inference analysis indicated that the early aggressive treatment approach was associated with a clinically meaningful 6.35-point improvement over the conservative approach in the PedsQL score at 12 months.
Writing in RMD Open, Huang and co-authors say: “A window of opportunity may exist where early effective DMARD treatment could address underlying disease pathophysiology, prevent structural damage in joints and prevent functional impairment.”
They conclude: “This study offers real-world evidence supporting the effectiveness of early aggressive treatment, consistently with the results from existing [randomized controlled trials].”
By Laura Cowen
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