Background/Purpose: The advent of new therapies for juvenile idiopathic arthritis (JIA), particularly the introduction of biologic medications, has increased considerably the potential for treatment benefit, with clinical remission being now a realistic goal for a substantial proportion of patients. However, the assessment of remission has seldom been incorporated in clinical trials of biologics in JIA. Moreover, little information exists on predictors of the effectiveness of biologic medications. The study aim was two-fold: 1) to evaluate the rate of inactive disease (ID) in children with juvenile idiopathic arthritis (JIA) treated with etanercept (ETN); 2) to identify clinical characteristics associated with attainment of ID.

Methods: The clinical chart of all consecutive JIA patients who were given ETN between 2002 and 2011, and had a follow-up of at least 6 months after ETN start were reviewed. For each patient, all visits made from ETN initiation to the last follow-up evaluation in which the patient was still receiving ETN were examined to establish whether the patient had reached the state of ID, defined by the Wallace criteria (J Rheum 2004;31:2290-4), and to identify the first visit in which ID was documented. Clinical characteristics associated with achievement of ID were sought for by means of univariate analyses and Cox regression procedures. Predictive factors included sex, age at disease onset, age and disease duration at treatment baseline, interval between first observation at study center and start of ETN, ILAR category, antinuclear antibody status, JIA outcome measures at ETN start, joints affected before ETN start, and medications administered before ETN start and administered concomitantly during ETN therapy.

Results: A total of 173 patients who received ETN for a median of 2.2 years (range 0.5-10.5 years) were included in the study. Eighty-seven patients (50.3%) achieved ID a median of 0.6 years (range, 0.1-2.5 years) after the initiation of ETN therapy. The rate of ID was much lower in children with systemic JIA than in those with non-systemic categories altogether (29.6% vs. 54.1%). At last follow up visit, 0.5 to 10.5 years after ETN start (median, 2.2 years), 85 patients (49.1%) still had ID and 70 patients (40.5%) met the criteria for clinical remission on medication. The probability of achievement of ID after 6, 12 and 24 months of therapy was 24%, 46% and 57%, respectively. On Cox regression analysis, the attainment of ID was associated with lack of wrist involvement [HR_Adj (95% CI): 2.19 (1.38 – 3.48), p=0.0006] and an age at onset < 3.6 years [HR_Adj (95% CI): 1.61 (1.04 – 2.49), p=0.03]. A secondary analysis made after the exclusion of the 27 children with systemic JIA led to identify the same predictors

Conclusion: Around half of our JIA patients treated with ETN in standard clinical care were able to achieve the state of ID. Children who lacked wrist involvement and had a younger age at disease onset had a greater likelihood of achieving ID during ETN administration. Thus, the presence of wrist disease and an older age at disease presentation may constitute an indication for the earlier introduction of ETN or its administration in combination with methotrexate.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-achievement-of-inactive-disease-in-children-with-juvenile-idiopathic-arthritis-treated-with-etanercept/