Improved JIA Outcomes Associated With Increased Use of Biologics, Decreased Use of Glucocorticoids

Improved outcomes in new-onset systemic juvenile idiopathic arthritis (sJIA) may be associated with increased use of biologics and decreased use of glucocorticoids, according to results of a study published in Pediatric Rheumatology.

Researchers at the Childhood Arthritis and Rheumatology Research Alliance (CARRA) conducted a prospective observational study (First-Line Options for sJIA Treatment [FROST]) to assess consensus treatment plan (CTP) outcomes among patients with sJIA. 

In the study, researchers included patients enrolled in CARRA registry sites between 2016 and 2019 who were recently diagnosed with sJIA. Patients who received biologic treatment with interleukin (IL)-1 or IL-6 inhibitors or nonbiologic treatment with glucocorticoid monotherapy or methotrexate were evaluated at 9 and 12 months.

Achieving clinical inactive disease (CID) was defined as a clinical juvenile arthritis disease activity score based on 10 joints (cJADAS-10) of 2.5 or lesser, with no fever or glucocorticoid use.

Of a total of 73 patients (median age, 6.8 years; 60.3% boys; and 65.8% White), the majority (86%) received biologic treatment with or without glucocorticoids; 59% received oral glucocorticoids at some time during their treatment. Among those who received biologics, 94% received IL-1 inhibitors. The patients who received vs did not receive biologic treatment had a higher number of active joints (mean, 7.0 vs 4.1 joints, respectively) and ferritin levels (median, 884 vs 363 ng/mL, respectively).

Choice of the CTP appeared to be strongly influenced by the clinician. The top 3 reasons for selecting a particular biologic treatment plan included likelihood of effectiveness for systemic features, minimization of glucocorticoid use, and likelihood of effectiveness for arthritic symptoms. The reasons for selecting a nonbiologic treatment plan included likelihood of effectiveness for systemic features, likelihood of effectiveness for arthritic symptoms, and safety.

The rate of achieving CID at 9 and 12 months was higher for the biologic treatment recipients (57%) compared with nonbiologic recipients (50%). The rates of achieving cJADAS-10 of 2.5 or lesser with no fever, regardless of glucocorticoids use, were 77% and 60% at 9 months and 79% and 60% at 12 months for the biologic and nonbiologic cohorts, respectively.

There were 16 grade-3 or higher safety events among 13 patients, including 1 death due to acute liver failure. All events occurred among biologic treatment recipients.

A major limitation of the study was its nonrandomized, observational design.

The study authors concluded, “It is strongly encouraging that the majority of patients with new onset sJIA had excellent outcomes, with less [glucocorticoid] usage than was necessary prior to the availability of biologics. The availability of biologics effective for treating sJIA has undoubtedly changed outcomes for the vast majority of patients with this disease. We look forward to following the outcomes of these patients in the longer term, since all FROST patients are enrolled in the CARRA Registry, enabling follow up for at least [10] years.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.