Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: The effectiveness of target use of biological medications depends on how personalized they are to fit patient’s individual parameters with juvenile idiopathic arthritis (JIA). The proper selection of biologicals allows one to reach maximum effectiveness and reduce the dosage of concomitant therapy. Both the steroid- and NSAID-sparing effects of biological drugs are the key aspects of the dynamics of patient’s condition. Purpose:To study the dynamics of concomitant treatment with NSAIDs and corticosteroids during etanercept treatment in patients with JIA.
This analysis was performed on 197 etanercept-naïve JIA patients (69.5% females) with median age of 7.25 years (IQR, 4−12 years). For each time point, as well as for the past medical history, the data on concomitant therapy were collected: the status of NSAID use, the fact of administration and dosage of oral glucocorticoids (orGC) and methotrexate (MTX). The effectiveness of primary therapy and the dynamics of concomitant therapy were analyzed after 3 months and every 6 months during the long-term follow-up (up to 4.5 years).
At the baseline, 162 (82.2%) patients received concomitant MTX; 10 (5.0%) patients, orGK; and 121 (61.4%) patients, NSAIDs. All patients with concomitant orGK received both ETA and MTX. No patients received intra-articular GK for the entire study period.
Within 1 year treatment with ETA, NSAIDs were discontinued in 114 (94.2%) patients, orGK were discontinued completely in 4 children (40%), and the dose of orGK was reduced in 1 patient (10%).
By the end of follow-up period, NSAIDs were withdrawn in 115 patients (95%), orGK were withdrawn in 4 (40%) patients, and were reduced in 4 (40%). Only one patient during the observation required an increase in dosage of orGK. During the entire period of observation, the appointment of NSAIDs or orGK was not required for any patient who had not previously received these drugs. There were no significant differences in the dynamics of withdrawal of NSAIDs in patients who received and did not receive MTX background therapy: the total withdrawal was 91 out of 96 (94.8%) patients in the MTX+ETA group vs 24 of 25 (96%) in the ETA group (p = 0.804). By the end of the follow-up period 36 (19.3%) of 187 patients who had any background therapy, could switch to ETA monotherapy.
Our results demonstrate that long-term therapy with ETA makes it possible to reduce the dosage or completely discontinue most concomitant therapy agents (orGK, NSAIDS, MTX) in a significant percentage of patients. This reduces the risk of development of NSAID- and GC-associated pathological conditions, while the effectiveness of therapy of the underlying condition remains high.
To cite this abstract in AMA style:Alexeeva E, Dvoryakovskaya T, Gladkikh V, Moskalev A, Denisova R, Isaeva K, Lomakina O, Soloshenko M, Karaseva A. Dynamics of Concomitant Therapy in Children with Juvenile Idiopathic Arthritis Treated with Etanercept [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/dynamics-of-concomitant-therapy-in-children-with-juvenile-idiopathic-arthritis-treated-with-etanercept/. Accessed February 26, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/dynamics-of-concomitant-therapy-in-children-with-juvenile-idiopathic-arthritis-treated-with-etanercept/