Support for early initiation of biologics in patients with severe JIA
medwireNews: Study results indicate that patients with severe juvenile idiopathic arthritis (JIA) who start biologic DMARDs within 2 years of symptom onset have better long-term outcomes than those who begin treatment later.
These findings support the theory of a “window of opportunity” for JIA treatment early in the disease course, say Kirsten Minden (German Rheumatism Research Center, Berlin) and study co-authors.
Of 566 biologic DMARD-treated patients with a disease duration of at least 10 years who were included in the BiKeR or JuMBO registries, 23% started biologics as a result of an inadequate response or intolerance to conventional DMARDs within 2 years of JIA onset, 31% started biologics between 2 and 5 years after onset, and the remainder were escalated later in the disease course. The majority of patients were given etanercept as their first biologic DMARD.
At the 10-year follow-up, those who started biologics within 2 years were significantly more likely to be in drug-free remission – defined as clinically inactive disease according to physician global assessment (PGA) of disease activity for at least 12 months without any treatment – than those starting biologics at 2–5 years or more than 5 years after disease onset, with rates of 18.5% versus 10.1% and 4.9%, respectively.
And the researchers found consistent results when drug-free remission was based on clinical Juvenile Arthritis Disease Activity Score (cJADAS; ≤1 point) rather than PGA, at corresponding rates of 15.7% versus 6.0% and 3.8%.
Moreover, patients starting biologics within 2 years had significantly lower average PGA disease activity and cJADAS scores than those starting biologics after 5 years, as well as less frequent limitations in function and overall wellbeing, report Minden and team in Arthritis Care & Research.
Although biologic DMARDs “are highly effective at slowing the inflammatory cascade [and] have become an integral part of JIA therapy,” these findings show that “therapy escalation is still taking place at very different times during the course of JIA,” say the researchers.
They acknowledge, however, that their study only included patients with severe JIA who qualified for biologic DMARD treatment and that the findings may not be applicable to all JIA patients.
Nonetheless, they conclude: “[W]e believe, to the best of our knowledge, that this study demonstrates the benefits of early intervention and effective disease activity control for optimal JIA long-term prognoses.”
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