Background/Purpose: The treatment of systemic juvenile idiopathic arthritis (SJIA) has changed dramatically over the past decade, associated with overall improvement in functional outcomes.  There may be an early “window of opportunity” where biologic therapies provide maximal benefit while decreasing morbidity associated with glucocorticoids.  The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry has enrolled more than 10,000 patients with pediatric rheumatic diseases. Our objectives were to use the CARRA Registry data to (1) assess trends in medication usage over time, and (2) determine if demographic factors affect the timing of IL-1 or IL-6 inhibitor (IL-1/6i) initiation.

Methods: Patients with SJIA enrolled in the CARRA registry between 2015 and 2018 were included. Medication information was collected retrospectively for all patients at enrollment in the Registry and prospectively after enrollment. Patients with missing month of diagnosis or medication start date were excluded. Medications were grouped by mechanism of action, and temporal trends in medication class usage were assessed using frequencies. Sub- analysis was performed looking at the timing of IL1/6i initiation (0-3 mo, 3-6 mo, 6-12 mo after diagnosis) was analyzed to determine if demographic factors contribute to timing of medication start.

Results: Of 493 patients included in the medication analysis (see Table 1 for demographics), 47.3% were treated with IL1/6i in the first 3 months, and 60% were treated with IL1/6i in the first year. Of the patients prescribed IL-1/6i in the first year after diagnosis, 79% began these treatments in the first 3 months of illness. No significant differences were found in timing of introduction of IL1/6i based on age, sex, race, or median time from symptom onset to diagnosis. Timing of IL1/6i introduction did not affect frequency of DMARD use in the first 12 months (Table 1). There was an upward trend in IL1/6i usage during the first year of treatment over time (Figure 1). Tumor necrosis factor inhibitor use declined over time.

Conclusion: In SJIA patients in the CARRA Registry enrolled over a 3-year period, there has been an increase in IL1/6i usage. Of those who used IL1/6i, the majority began treatment in the first three months of disease. This does not appear to vary by age of diagnosis, time from symptom onset to diagnosis, race/ethnicity, or methotrexate use. Our findings may reflect the significant impact of provider preference, and the data regarding a possible “window of opportunity” early in the course of disease. Use of non-biologic DMARDs did not significantly change over the study period. More study is needed to assess the impact of early initiation of IL-1/6i on outcomes in SJIA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-systemic-juvenile-idiopathic-arthritis-in-the-carra-registry/