Concomitant Initiation of csDMARDs and bDMARDs Increases Remission Rates in JIA

A higher percentage of patients with polyarticular juvenile idiopathic arthritis (pJIA) who were initiated on treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs) concomitantly were found to achieve clinical remission compared with patients who were initiated on csDMARDs with later addition of bDMARDs, according to study results presented at the American College of Rheumatology (ACR) Convergence 2022, held from November 10 to 14, in Philadelphia, Pennsylvania.

The STOP-JIA study (Start Time Optimization of Biologics in Polyarticular JIA; ClinicalTrials.gov Identifier: NCT02593006) is a prospective, observational study to compare the effectiveness of 3 Childhood Arthritis & Rheumatology Research Alliance (CARRA) consensus-derived treatment strategies (CTPs) in achieving clinically inactive disease in patients with untreated pJIA.

• Step Up: Patients were started on treatment with a csDMARD, and a bDMARD was added if needed after at least 3 months;
• Early Combination: Patients were started on treatment with a csDMARD and bDMARD concomitantly; and
• Biologic First: Patients were started on treatment with a bDMARD as monotherapy.

Data were collected using the CARRA registry every 3 months for the first 12 months, then every 6±3 months thereafter. Patients with 36±6 months of follow-up were included in the current analysis.

The primary outcome was the percentage of participants with clinically inactive disease off glucocorticoids. The secondary outcome was comparison of Patient Reported Outcomes Measurement Information System (PROMIS) pain and mobility scores between the 3 treatment groups.

A total of 297 patients with pJIA had a 3-year visit (Step Up, n=190; Early Combination, n=76; Biologic First, n=31). At 3 years, researchers measured the percentage of children achieving clinically inactive disease off glucocorticoids, the clinical Juvenile Arthritis Disease Activity Score based on 10 joints (cJADAS10) inactive disease (defined as a score of ≤2.5), and clinical remission.

At 3 years, there was no difference between the 3 treatment groups in percentage of patients with clinically inactive disease and cJADAS10 inactive disease. However, more patients in the Early Combination vs Step Up group achieved clinical remission at any time in the study (Early Combination, 67.1% vs Step Up, 47.3%; P =.007) and spent a greater percentage of time in both clinically inactive disease (Early Combination, 39.2% vs Step Up, 27.3%; P =.006) and cJADAS10 inactive disease (Early Combination, 50.6% vs Step Up, 37.5%; P =.005).

The researchers noted that while “there were no significant differences between [patients with] pJIA in the 3 CTP groups in achieving [clinically inactive disease] or cJADAS10 ID at the 3 year timepoint,” concomitant initiation of a csDMARD and bDMARD significantly improved chances of clinical remission.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.