Biologic, conventional DMARDs achieve better results in JIA when started together
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PHILADELPHIA — Patients with juvenile idiopathic arthritis started on conventional synthetic and biologic disease-modifying antirheumatic drug therapy concurrently had better results than patients on other plans, according to data presented here.
“The STOP-JIA study is one of the largest prospective research studies in new and untreated patients with poly JIA,” Yukiko Kimura, MD, the chief of the division of rheumatology at Hackensack University Medical Center in New Jersey, said during a press conference at ACR Convergence 2022. “This disease can begin at any age in childhood, and by definition, affects five or more joints.”
Kimura and colleagues initiated the CARRA STOP-JIA study to investigate the impact of three different consensus treatment plans in patients with juvenile idiopathic arthritis. Patients were not randomized, and data was collected every 3 months for the first year, and then every 6 months after. Patients were only included in this analysis if they had more than 36 months of follow-up data available.
The three consensus treatment plans were characterized as Step Up, where patients began a conventional synthetic DMARD and added a biologic DMARD after 3 months if needed, Early Combination, where patients started cs- and bDMARDs simultaneously, and Biologic First, where patients received biology therapy only. Endpoints of interest to the researchers included the proportion of patients who achieved clinically inactive disease while off glucocorticoids, the clinical Juvenile Arthritis Disease Activity Score based on 10 joints (cJADAS10) and clinical remission for 6 or more months, the researchers wrote.
In total, 297 patients with polyarticular JIA were included in the analysis. There were 190 patients in the Step Up, group, 76 in the Early Combination group and 31 in the Biologic First, group. After 3 years, there was no difference between groups in terms of percentages who achieved clinically inactive disease and cJADAS10 disease scores. The proportion of patients who achieved clinical remission at any time (Early Combination: 50.6%, Step Up: 47.3% P = .007), as well as the percentage of time patients in the Early Combination group spent with Clinically Inactive Disease (P = .006) and cJADAS10 disease scores (P = .005) was significantly higher than patients in the Step Up group, Kimura and colleagues wrote.
“This study shows that the treatment that polyarticular JIA patients receive very early on in their disease matters, even 3 years after that treatment was started,” Kimura said during the press conference. “Despite effective biologic treatments, we found that 40% to 60% of patients with polyarticular JIA did not achieve inactive disease.”
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Kimura Y. Abstract #1679. Presented at: ACR Convergence 2022; Nov. 10-15, 2022 (hybrid meeting).
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