Polyarticular JIA patients achieved inactive disease with early, aggressive therapy

SAN DIEGO — A majority of patients with polyarticular juvenile idiopathic arthritis achieved clinical inactive disease within 1 year of receiving aggressive therapy, according to research presented at the American College of Rheumatology annual meeting.

“You get the best outcome when children are treated early in their disease, and if they’re treated aggressively,” researcher Carol A. Wallace, MD, professor of pediatrics at Seattle Children’s Hospital, University of Washington, told Healio.com.

Wallace and colleagues conducted a double blind, placebo-controlled trial of 85 patients aged 2 to 17 years with polyarticular juvenile idiopathic arthritis (JIA) less than 12 months in duration. Patients were randomly assigned a more aggressive treatment (M-E-P; n=42) that included 0.5 mg/kg/week injection of methotrexate (MTX), 0.8 mg/kg/week etanercept and 0.5 mg/kg/day prednisolone tapered to zero by 17 weeks. A second group (MTX; n=43) was assigned less-aggressive therapy of 0.5 mg/kg/week MTX subcutaneously and placebo etanercept and prednisolone. Clinical inactive disease (CID) was assessed at 1, 2, 4, 5, 6, 7, 8, 10 and 12 months. If patients failed to reach an ACR Pedi 70 at 4 months or CID at 6 months, they were switched to open-label M-E-P.

Thirty patients (71%) assigned aggressive therapy and 28 patients (65%) in the less-aggressive treatment group achieved CID at least once. Among M-E-P patients, median number of days on aggressive therapy until the first CID occurrence was 168.5 days, compared with 192 days for the MTX cohort. A median of 139.5 days (42%) of follow-up with CID was experienced by M-E-P patients, compared with 79 days (24%) for MTX patients (P=.016).

M-E-P patients had CID at 34% of follow-up visits; MTX starters reached CID at 24% of visits.

CID was evident in a median of 40% of visits for patients with disease duration of 3 months or less at enrollment, compared with a median of 11% of visits for patients with disease of more than 3 months (P<.0001).

Forty-nine patients achieved ACR Pedi 70 at 4 months, with CID achieved by 42 patients (86%).

“A short disease duration prior to the start of aggressive therapy and attainment of an ACR Pedi 70 by 4 months are significant predictors of achieving sustained CID,” the researchers concluded.

Disclosure: See the abstract for a full list of relevant financial disclosures.

For more information:

Wallace CA. #790: Predictors and Sustainability of Clinical Inactive Disease in Polyarticular Juvenile Idiopathic Arthritis Given Aggressive Therapy Very Early in the Disease Course. Presented at: the 2013 American College of Rheumatology Annual Meeting; Oct. 26-30, San Diego.