Treat-to-Target Study for Improved Outcome in Polyarticular Juvenile Idiopathic Arthritis

Gerd Horneff¹, Ivan Foeldvari², Ralf Trauzeddel³, Toni Hospach⁴, Kirsten Minden⁵, Hans-Iko Huppertz^6,7 and Ariane Klein⁸, ¹Asklepios Klinik Zentrum für Allgemeine Paediatrie und Neonatologie, Sankt Augustin, Germany, ²Hamburger Zentrum fur, Kinder-und Jugendrheumatologie, Hamburg, Germany, ³Helios Clinics, Berlin, Germany, ⁴Pediatrics, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany, ⁵Charité–Universitätsmedizin Berlin, Berlin, Germany, ⁶Prof Hess Clinic, Bremen, Germany, ⁷Prof. Hess Childrens Hospital, Bremen, Germany, ⁸Center of Pediatrics and Neonatology, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Biologic drugs, Juvenile arthritis and treatment

Session Information

Date: Sunday, October 21, 2018

Title: 3S115 ACR/ARHP Abstract: Pediatric Rheum (976–981)

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Juvenile idiopathic arthritis (JIA) is one of the most prevalent chronic diseases of childhood and adolescence. Evidence suggests that early effective treatment is important to minimize the burden of disease during childhood and in further life. We hypothesize that a guided treat to target (T2T) approach as recommended by the German Society for Pediatric Rheumatology (1) is superior to routine care in polyarticular JIA (pJIA) in terms of reaching a clinical state of remission after 12 months of treatment.

Methods: After informed consent, patients with early (disease duration ≤ 12 months) and active (JADAS10 ≥ 5.4) pJIA were enrolled. Targets for treatment were defined by the level of improvement and are progressively more rigourous with ongoing treatment. Failure to meet a defined target required modification of treatment at specified intervals. Initially, all patients received methotrexate(MTX). The choice of biologic was made by shared decision between the investigator and the patient/parent and not influenced by the protocol. Minimal treatment target defined as recognizable improvement of disease activity (2) was demanded after 3 months of treatment. Until month 6, a JADAS acceptable disease status, until month 9 JADAS MDA and at month 12 JADAS-remission should be reached.

Results: Altogether 58 patient with non-systemic JIA (44/7 RF negative/RF positive polyarthritis, 3 extended Oligoarthritis, 1 ERA, 1PsA)were included (mean age 9.2+/-4.9 years, disease duration 0.4+/-0.6 years). At month 3; 37/51 (72.5%) of patients showed JADAS improvement. In 13 (25.5%) treatment with a biologic was started. At month 6, 32/41 (78%) had JADAS improvement and 30/41 (73.2%) reached JADAS acceptable disease. In 6 (14.6%) a biologic agent was started. At month 9, 34/37 (92%) showed JADAS improvement, 28/37 (76%) reached JADAS acceptable disease and 23/37 (62%) reached JADAS-MDA. In 4 (10.8%) a biologic was started and one patient switched biologics. So far, 30 patients completed 12 months of observation. JADAS MDA was reached by 22 (76%) and JADAS remission was reached by 13 (45%). In total 24 patients were treated with a biologic agent, 12 (41%) of those were followed until month 12 with 3 patients (25%) reaching JADAS remission and 7 (58%) JADAS MDA. 17 patients were treated with MTX only over 12 months of whom 10 (59%) reached JADAS remission and 15 (88%) JADAS MDA.

N	Baseline n=58	Month 3 n=51	Month 6 n=41	Month 9 n=37	Month 12 n=30
JADAS- minimal response	n.a.	72,5%	78,0%	91,9%	96.5%
JADAS acceptable disease (≤5.4)	0,0%	43,1%	73,2%	75,7%	79.3%
JADAS MDA (≤3.8)	0,0%	33,3%	61,0%	62,2%	75.8%
JADAS Remission (≤1)	0,0%	19,6%	31,7%	43,2%	44.8%
NSAIDs	41,4%	25,5%	12,2%	5,4%	0,0%
Steroids	36,2%	31,4%	12,2%	5,4%	3,3%
MTX	100,0%	88,2%	100,0%	83,8%	76,7%
Biologics	0,0%	25,5%	36,6%	40,5%	41.4%
2nd biologic	0,0%	0,0%	0,0%	2,7%	3,3%

Conclusion: These preliminary data indicate that a T2T concept is feasible. A high rate of patients reached JADAS MDA and JADAS remission after 12 months of treatment. Interestingly, about 60% of patients did not need to be treated with a biologic to reach predefined T2T (2). Thus, the early response seems advantageous indicating a window of opportunity to successfully treat polyarticular JIA.

1. Horneff G et al Pediatr Rheumatol Online J. 2017; 15:78

2. Horneff G et Becker I. Rheumatology. 2014;53:1229-34.

Disclosure: G. Horneff, None; I. Foeldvari, None; R. Trauzeddel, None; T. Hospach, None; K. Minden, None; H. I. Huppertz, None; A. Klein, None.

To cite this abstract in AMA style:

Horneff G, Foeldvari I, Trauzeddel R, Hospach T, Minden K, Huppertz HI, Klein A. Treat-to-Target Study for Improved Outcome in Polyarticular Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/treat-to-target-study-for-improved-outcome-in-polyarticular-juvenile-idiopathic-arthritis/. Accessed .

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