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Early DMARD use linked to improved JIA control, outcomes
Early treatment with disease-modifying antirheumatic drugs is associated with improved disease control and outcomes among patients with juvenile idiopathic arthritis, according to findings published in Arthritis Care & Research.
“Up to 50% of JIA cases exhibit a polyarticular disease course and are therefore at high risk of disease activity into adult life, permanent functional disability and progressive joint damage,” Kirsten Minden, MD, of the German Rheumatism Research Center Berlin, and colleagues wrote. “It is thought that early intervention and the consequent suppression of disease activity may hamper disease progression in such a way that chronicity is reduced. However, the optimum time for initiating [biological] DMARDs has not yet been determined, as reflected by a prescription rate of approximately 20% within the first 5 years of the disease.”
To analyze long-term outcomes among patients with JIA in terms of when biological DMARD treatment is initiated, the researchers retrieved data from the ongoing BiKeR and JuMBO, multicenter, prospective observational cohort studies. The trials are evaluating the safety and effectiveness of conventional synthetic and biological DMARDs, with JuMBO acting as the follow-up register to BiKeR.
For their own study, Minden and colleagues included 701 patients with JIA who enrolled into BiKeR during their childhood and later transferred to JuMBO, began initial biological DMARD therapy and completed at least one physician assessment during young adulthood.
Patients in both trials were assessed every 6 months regarding drug-free remission and inactive disease, functional status and quality of life and surgery. For their analysis, Minden and colleagues organized the 701 included patients into three groups based on time from the first appearance of symptoms to biological DMARD initiation: 2 or fewer years in group one, 2 to 5 years in group two and more than 5 years in group three. In addition, the researchers analyzed propensity score-adjusted outcome differences using multinomial logistic regression.
According to the researchers, the patients were followed for 9.1 ± 3.7 years. At last follow-up, 11.7% of the participants had achieved drug-free remission, and 40% had inactive disease status. In addition, more than half of the participants demonstrated no functional limitation. At 10 years, the 108 patients in group one were significantly more likely to have achieved drug-free remission than the 199 participants in group two or the 259 in group three. In addition, patients in group one had significantly lower disease activity, a better overall wellbeing and higher functional status compared to patients in group three. Participants in group one also required arthroplasty significantly less frequently than those in group three, and had significantly lower disease activity over time than patients in groups two and three.
“We 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,” Minden and colleagues wrote. “In patients who have failed [conventional synthetic] DMARDs, an escalation to [biological] DMARDs within the first two years of disease seems beneficial. Which patients are to be escalated early should be further investigated.” – by Jason Laday
Disclosure: Minden reports honoraria from AbbVie, Biermann, Chugai, Medac, Sanofi and Roche. Please see the study for all other authors’ relevant financial disclosures.