In:
Annals of the Rheumatic Diseases, BMJ, Vol. 78, No. 1 ( 2019-01), p. 51-59
Abstract:
Which is the best strategy to achieve (drug-free) inactive disease in juvenile idiopathic arthritis (JIA)? Methods In a randomised, single-blinded, study in disease-modifying anti-rheumatic drug (DMARD)-naive patients with JIA, three treatment-strategies were compared: (1) sequential DMARD-monotherapy (sulfasalazine or methotrexate (MTX)), (2) combination therapy MTX + 6 weeks prednisolone and (3) combination therapy MTX +etanercept. Treatment-to-target entailed 3-monthly DMARD/biological adjustments in case of persistent disease activity, with drug tapering to nil in case of inactive disease. After 24 months, primary outcomes were time-to-inactive-disease and time-to-flare after DMARD discontinuation. Secondary outcomes were adapted ACRPedi30/50/70/90 scores, functional ability and adverse events. Results 94 children (67 % girls) aged median (IQR) 9.1 (4.6–12.9) years were enrolled: 32 in arms 1 and 2, 30 in arm 3. At baseline visual analogue scale (VAS) physician was mean 49 (SD 16) mm, VAS patient 53 (22) mm, erythrocyte sedimentation rate 12.8 (14.7), active joints median 8 (5–12), limited joints 2.5 (1–4.8) and Childhood Health Assessment Questionnaire score mean 1.0 (0.6). After 24 months, 71% (arm 1), 70% (arm 2) and 72% (arm 3) of patients had inactive disease and 45% (arm 1), 31% (arm 2) and 41% (arm 3) had drug-free inactive disease. Time-to-inactive-disease was median 9.0 (5.3–15.0) months in arm 1, 9.0 (6.0–12.8) months in arm 2 and 9.0 (6.0–12.0) months in arm 3 (p=0.30). Time-to-flare was not significantly different (overall 3.0 (3.0–6.8) months, p=0.7). Adapted ACR pedi-scores were comparably high between arms. Adverse events were similar. Conclusion Regardless of initial specific treatments, after 24 months of treatment-to-target aimed at drug-free inactive disease, 71% of recent-onset patients with JIA had inactive disease (median onset 9 months) and 39% were drug free. Tightly controlled treatment-to-target is feasible. Trial registration number 1574.
Type of Medium:
Online Resource
ISSN:
0003-4967
,
1468-2060
DOI:
10.1136/annrheumdis-2018-213902
DOI:
10.1136/annrheumdis-2018-213902.supp1
DOI:
10.1136/annrheumdis-2018-213902.supp2
DOI:
10.1136/annrheumdis-2018-213902.supp3
DOI:
10.1136/annrheumdis-2018-213902.supp4
DOI:
10.1136/annrheumdis-2018-213902.supp5
DOI:
10.1136/annrheumdis-2018-213902.supp6
DOI:
10.1136/annrheumdis-2018-213902.supp8
DOI:
10.1136/annrheumdis-2018-213902.supp10
DOI:
10.1136/annrheumdis-2018-213902.supp9
DOI:
10.1136/annrheumdis-2018-213902.supp7
Language:
English
Publisher:
BMJ
Publication Date:
2019
detail.hit.zdb_id:
1481557-6
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