Early Initiation of Biologic Treatment Linked to Better Disease Outcomes in Juvenile Idiopathic Arthritis

Early initiation of biologic treatment for juvenile idiopathic arthritis (JIA) was found to be associated with a greater likelihood of remission and better disease outcomes, according to study data presented American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

The current retrospective study enrolled 55 patients with JIA who were initiated with biologic treatment up to 24 months after diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR], 3-13 years); median age at start of biologic treatment, 9 years (IQR, 3-13 years). The most commonly represented JIA subtypes included oligoarticular persistent JIA (25.5%), systemic JIA (18.2%), and enthesitis-related arthritis (16.4%). Conventional disease-modifying antirheumatic drugs were the most commonly prescribed biologics (83.6%). Overall, 54.5% of patients were initiated with biologic treatment within 6 months of diagnosis, 27.3% from 7 to 12 months, 12.7% from 13 to 18 months, and 5.5% from 19 to 24 months.

Two years after diagnosis, 78.2% of patients were in remission. Compared with patients with other types of JIA, those with oligoarticular extended JIA, polyarticular factor negative JIA, and psoriatic arthritis were more likely to have active disease at 24 months (P =.004).

Timing of therapy initiation was strongly correlated with likelihood of remission at 24 months. Patients in remission vs active disease at 24 months had an earlier start to their treatment (P =.029). Compared with patients who were initiated with biologic treatment within 7.5 months of diagnosis, those who were initiated after 7.5 months were more likely to have active disease at 24 months. In addition, prompter medication start was associated with a shorter time to remission (P =.024). Patients with active disease than those in remission at 24 months required more biologic treatment during follow-up, regardless of treatment initiation window (P =.002).

These data suggest that prompt initiation of biologic treatment was correlated with better outcomes in patients with JIA. While further research is necessary to confirm these findings, the results support the existence of a “therapeutic window” for biologic treatment in JIA.

Disclosure: A study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Boteanu AL, Briones-Figueroa A, Calvo-Sanz L, Suárez ÁA, García-Fernández A. Early start of biological treatment in juvenile idiopathic arthritis: does a therapeutic window exist in real life? Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0710.