Biologic, conventional DMARDs are more effective in JIA when started together

November 14, 2022

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Kimura Y. Abstract #1679. Presented at: ACR Convergence 2022; Nov. 10-15, 2022 (hybrid meeting).

Kimura reports financial information to Genentech.

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PHILADELPHIA — Patients with juvenile idiopathic arthritis who started conventional synthetic and biologic disease-modifying rheumatoid arthritis drugs had better outcomes than patients on other programs, according to data presented here.

“The STOP-JIA study is one of the largest prospective studies of new and untreated patients with poly JIA,” Yukiko Kimura, MD, chief of rheumatology at Hackensack University Medical Center in New Jersey, said at a press conference at ACR Convergence 2022. “This disease can start at any age in childhood, and by definition it affects five or more joints.

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“This study shows that the treatment given to poly JIA patients very early in the disease makes a difference, even 3 years after the start of treatment,” Yukiko Kimura, MD, said. Source: Adobe Stock

Kimura and colleagues initiated the CARRA STOP-JIA trial to investigate the effects of three different treatment regimens in consultation in patients with juvenile idiopathic arthritis. Patients were not randomized and data were collected every 3 months for the first year and then every 6 months thereafter. Patients were only included in this analysis if they had more than 36 months of follow-up data available.

Three consensus treatment plans were characterized as Step Up, where patients started conventional synthetic DMARDs and added a biologic DMARD after 3 months if needed, Early Combination, where patients started cs- and bDMARDs simultaneously, and Biologic First, where patients received biologic therapy . only. Endpoints of interest to the investigators included the proportion of patients who achieved clinically inactive disease while off glucocorticoids, the 10-item Juvenile Rheumatoid Disease Clinical Activity Score (cJADAS10), and clinical remission of 6 months or longer, the researchers wrote.

A total of 297 patients with polyarticular JIA were included in the analysis. There were 190 patients in the Step Up group, 76 in the Early Combination group and 31 in the Biologic First group. At 3 years, there were no differences between groups in terms of rates achieving clinically inactive disease and cJADAS10 disease scores. Proportion of patients achieving clinical remission at any time (early combination: 50.6%, stage up: 47.3% P = .007), as well as the proportion of time patients in the early combination therapy group had clinically inactive disease (P = .006) and cJADAS10 disease score (P = .005) was significantly higher than patients in the Step Up group, Kimura and colleagues wrote.

“This study shows that the treatment that multi-JIA patients receive very early in the disease makes a difference, even 3 years after the start of treatment,” Kimura said at the press conference. “Despite effective biologic therapy, we found that 40% to 60% of patients with polymyalgia JIA did not achieve inactive disease.”

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