☆ 4.2 Article

First-line options for systemic juvenile idiopathic arthritis treatment: an observational study of Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans

PEDIATRIC RHEUMATOLOGY (2022)

期刊

PEDIATRIC RHEUMATOLOGY

卷 20, 期 1, 页码 -

出版社

BMC

DOI: 10.1186/s12969-022-00768-6

关键词

Systemic juvenile idiopathic arthritis; Juvenile idiopathic arthritis; Still's disease; Treatment; Biologics

类别

Pediatrics Rheumatology

资金

Genentech , a member of the Roche Group
CARRA
NIAMS
Patient-Centered Outcomes Research Institute [2R01AR065538, R01AR073201, U19AR069522]
[PaCr-2017C2-8177]

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摘要

This study developed consensus treatment plans for systemic juvenile idiopathic arthritis (sJIA) and observed the outcomes of different treatment plans. The results showed that nearly all patients received treatment with biologics, and 46% of patients in the biologic treatment group did not receive oral glucocorticoid within the first month of treatment. Overall, the majority of patients had favorable clinical outcomes.

Background: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) to compare treatment initiation strategies for systemic juvenile idiopathic arthritis (sJIA). First-line options for sJIA treatment (FROST) was a prospective observational study to assess CTP outcomes using the CARRA Registry. Methods: Patients with new-onset sJIA were enrolled if they received initial treatment according to the biologic CTPs (IL-1 or IL-6 inhibitor) or non-biologic CTPs (glucocorticoid (GC) monotherapy or methotrexate). CTPs could be used with or without systemic GC. Primary outcome was achievement of clinical inactive disease (CID) at 9 months without current use of GC. Due to the small numbers of patients in the non-biologic CTPs, no statistical comparisons were made between the CTPs. Results: Seventy-three patients were enrolled: 63 (86%) in the biologic CTPs and 10 (14%) in the non-biologic CTPs. CTP choice appeared to be strongly influenced by physician preference. During the first month of follow-up, oral GC use was observed in 54% of biologic CTP patients and 90% of non-biologic CTPs patients. Five (50%) non-biologic CTP patients subsequently received biologics within 4 months of follow-up. Overall, 30/53 (57%) of patients achieved CID at 9 months without current GC use. Conclusion: Nearly all patients received treatment with biologics during the study period, and 46% of biologic CTP patients did not receive oral GC within the first month of treatment. The majority of patients had favorable short-term clinical outcomes. Increased use of biologics and decreased use of GC may lead to improved outcomes in sJIA.

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Disparities in the prevalence of clinical features between systemic juvenile idiopathic arthritis and adult-onset Still's disease

Piero Ruscitti, Valentina Natoli, Alessandro Consolaro, Roberta Caorsi, Silvia Rosina, Gabriella Giancane, Roberta Naddei, Ilenia Di Cola, Claudia Di Muzio, Onorina Berardicurti, Daniela Iacono, Ilenia Pantano, Gelsomina Rozza, Silvia Rossi, Ludovico De Stefano, Silvia Balduzzi, Antonio Vitale, Francesco Caso, Luisa Costa, Marcella Prete, Luca Navarini, Annamaria Iagnocco, Fabiola Atzeni, Giuliana Guggino, Federico Perosa, Luca Cantarini, Bruno Frediani, Carlomaurizio Montecucco, Francesco Ciccia, Paola Cipriani, Marco Gattorno, Roberto Giacomelli, Angelo Ravelli

Summary: This study compares the clinical features and treatments of systemic JIA and adult-onset Still's disease. The results reveal remarkable disparities in the prevalence of clinical manifestations between the two illnesses, which may partly depend on their classification by different criteria.

RHEUMATOLOGY (2022)