Date: Saturday, November 7, 2020
Session Title: Pediatric Rheumatology – Clinical Poster II: JIA
Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Data about when is the best moment to start BT in Juvenile Idiopathic Arthritis (JIA) patients and the impact of this prompt initiation are scarce.Our aim is to analyze the response to BT of JIA patients according to the time when the BT was started.
Methods: A retrospective, descriptive study of JIA patients followed up in a referral hospital that started BT up to 24 months after diagnosis from 2000 to 2018. Disease activity was measured, at 2 years after diagnosis, according to Wallace criteria for remission for at least 6 months.
Results: 55 JIA patients that started BT up to 24 months from diagnosis were analyzed. 69,1% were girls. The median age at diagnosis was 8 years IQR(3-13) and the median age at the start of BT was 9 years IQR(3-13). Regarding JIA categories: 25,5% were Oligoarticular Persistent (OligP), 18,2% Systemic JIA (sJIA), 16,4% Entesitis related Arthritis (ERA), 12,7% Psoriatic Arthritis (APso) and Polyarticular RF- (PolyRF-), 5,5% Oligoarticular Extended (OligE) and Polyarticular RF+ (PolyRF+), 3,6% Undifferentiated (Und). 20% of patients had uveitis during followup.
Conventional DMARD (cDMARD) was indicated in 83,6% of patients (95,7% Methotrexate) at diagnosis [median 0 months IQR(0-2,3)]. At the end of followup only 30,9% of patients continued with cDMARDs. The main causes of discontinuation were: adverse events (46,7%), remission (36,7%). TNF inhibitors were prescribed in 81,8% of patients and 18,2% of patients received two BT during the study period. 54,5% of BT were indicated during the first 6 months from diagnosis, 27,3% from 7 to 12 months, 12,7% from 13 to 18 months, 5,5% from 19 to 24 months.
After 2 years from diagnosis, 78,2% of patients were on remission and 21,8% active. Among patients with active disease: 75% had arthritis, 16,7% had uveitis and 8,3% had both. There were no differences regarding disease activity among patients with uveitis and neither taking cDMARDs. Regarding JIA categories: 66,7% of OligE, 57,1% of PolyRF- and 57,1% of APso patients were active at 2 years from diagnosis when compared to the other categories (p=0.004).
Patients on remission at 24 months from diagnosis started sooner the BT than active patients [CI 95% (0,46-8,29) p=0,029]. The time when the BT was started was correlated to the activity at 2 years (K= 0,294 p=0,029). When the BT was prescribed after 7,5months from diagnosis it was correlated, in a COR curve, with a higher probability of active disease at 2 years (S=0,67 E=0,63). There was a correlation, among patients on remission at 2 years, between prompt start of BT and less time to reach remission (K= -0,345 p=0,024). Patients with active disease at 2 years, regardless of moment of BT initiation, required more BT during follow-up (p=0,002).
Conclusion: Prompt initiation of BT was correlated with a better outcome. JIA patients that started BT early after diagnosis had a higher probability of remission after 2 years. Starting BT after 7,5 months was correlated with a higher probability of active disease at 2 years. Active disease at 24 months was correlated with presistent active disease during follow-up
To cite this abstract in AMA style:Boteanu A, Briones-Figueroa A, Calvo-Sanz L, Andreu Suárez �, García-Fernández A. Early Start of Biological Treatment in Juvenile Idiopathic Arthritis: Does a Therapeutic Window Exist in Real Life? [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/early-start-of-biological-treatment-in-juvenile-idiopathic-arthritis-does-a-therapeutic-window-exist-in-real-life/. Accessed March 27, 2023.
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