Dose reduction and discontinuation of disease-modifying anti-rheumatic drugs (DMARDs) for juvenile idiopathic arthritis

2022 ◽  
Vol 2022 (1) ◽  
Author(s):  
William D Renton ◽  
Georgina Tiller ◽  
Jane Munro ◽  
Joachim Tan ◽  
Renea V Johnston ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Dose Reduction ◽  
Disease Modifying

scholarly journals Re-treatment with etanercept is as effective as the initial firstline treatment in patients with juvenile idiopathic arthritis

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Jens Klotsche ◽  
Ariane Klein ◽  
Martina Niewerth ◽  
Paula Hoff ◽  
Daniel Windschall ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Response To Therapy ◽  
Inactive Disease ◽  
Window Of Opportunity ◽  
Younger Age ◽  
Synthetic Dmards ◽  
Disease Modifying ◽  
Mean Time ◽  
Active Disease ◽  
Subsequent Risk

Abstract Objectives To determine (i) correlates for etanercept (ETA) discontinuation after achieving an inactive disease and for the subsequent risk of flare and (ii) to analyze the effectiveness of ETA in the re-treatment after a disease flare. Methods Data from two ongoing prospective registries, BiKeR and JuMBO, were used for the analysis. Both registries provide individual trajectories of clinical data and outcomes from childhood to adulthood in juvenile idiopathic arthritis (JIA) patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) and conventional synthetic DMARDs (csDMARDs). Results A total of 1724 patients were treated first with ETA treatment course (338 with second, 54 with third ETA course). Similar rates of discontinuation due to ineffectiveness and adverse events could be observed for the first (19.4%/6.2%), second (18.6%/5.9%), and third (14.8%/5.6%) ETA course. A total of 332 patients (+/−methotrexate, 19.3%) discontinued ETA after achieving remission with the first ETA course. Younger age (hazard ratio (HR) 1.08, p < 0.001), persistent oligoarthritis (HR 1.89, p = 0.004), and shorter duration between JIA onset and ETA start (HR 1.10, p < 0.001), as well as good response to therapy within the first 6 months of treatment (HR 1.11, p < 0.001) significantly correlated to discontinuation with inactive disease. Reoccurrence of active disease was reported for 77% of patients with mean time to flare of 12.1 months. We could not identify any factor correlating to flare risk. The majority of patients were re-treated with ETA (n = 117 of 161; 72.7%) after the flare. One in five patients (n = 23, 19.7%) discontinued ETA again after achieving an inactive disease and about 70% of the patients achieved an inactive disease 12 months after restarting ETA. Conclusion The study confirms the effectiveness of ETA even for re-treatment of patients with JIA. Our data highlight the association of an early bDMARD treatment with a higher rate of inactive disease indicating a window of opportunity.

Principles of management of juvenile idiopathic arthritis

2013 ◽  
pp. 725-733 ◽  
Author(s):  
Nicolino Ruperto ◽  
Angelo Ravelli
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Control ◽  
Physical Therapist ◽  
Well Being ◽  
Standards Of Care ◽  
Pharmacological Interventions ◽  
American College Of Rheumatology ◽  
Systemic Corticosteroids ◽  
Biologic Response ◽  
Disease Modifying

The management of juvenile idiopathic arthritis (JIA) is based on a combination of pharmacological interventions, physical and occupational therapy, and psychosocial support. Ideally, the management is conducted by a multidisciplinary team composed by a paediatric rheumatologist, specialist nurse, physical therapist, occupational therapist, and psychologist. The treatment is aimed to achieve disease control, to relieve pain, to foster normal nutrition and growth, to maintain physical and psychological well-being, and to prevent long-term damage related to the disease or its therapy. First-line pharmacological interventions are based on non-steroidal anti-inflammatory drugs and intra-articular corticosteroids. Patients who are refractory to these therapies are candidates to receive disease-modifying anti-rheumatic medications, namely methotrexate or, in case of enthesitis-related arthritis, sulfasalazine. If therapeutic response is inadequate or suboptimal, the introduction of a biologic response modifier is considered. Systemic corticosteroids are used in selected instances, which include the management of extra-articular manifestations of systemic arthritis or the achievement of quick disease control while are awaiting the full therapeutic effect of a disease-modifying agent in patients with severe polyarthritis. To help physician select the safest and most effective treatment for JIA, the American College of Rheumatology (ACR) has issued a set of recommendations that were meant to be as evidence based as possible. The British Society for Paediatric and Adolescent Rheumatology (BSPAR) has developed the standards of care for patients with JIA, which are aimed to help the paediatric rheumatology teams to improve the service they provide.

scholarly journals Disease-modifying Antirheumatic Drug Use in the Treatment of Juvenile Idiopathic Arthritis: A Cross-sectional Analysis of the CARRA Registry

2012 ◽  
Vol 39 (9) ◽  
pp. 1867-1874 ◽  
Author(s):  
TIMOTHY BEUKELMAN ◽  
SARAH RINGOLD ◽  
TREVOR E. DAVIS ◽  
ESI MORGAN DeWITT ◽  
CHRISTINA F. PELAJO ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Medication Use ◽  
The United States ◽  
Antirheumatic Drug ◽  
Patient Factors ◽  
Cross Sectional ◽  
Biologic Dmard ◽  
Disease Modifying ◽  
Disease Modifying Antirheumatic Drug ◽  
Systemic Arthritis

Objective.To characterize disease-modifying antirheumatic drug (DMARD) use for children with juvenile idiopathic arthritis (JIA) in the United States and to determine patient factors associated with medication use.Methods.We analyzed cross-sectional baseline enrollment data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from May 2010 through May 2011 for children with JIA. Current and prior medication use was included. We used parsimonious backward stepwise logistic regression models to calculate OR to estimate associations between clinical patient factors and medication use.Results.We identified 2748 children with JIA with a median disease duration of 3.9 years from 51 US clinical sites. Overall, 2023 (74%) had ever received a nonbiologic DMARD and 1246 (45%) had ever received a biologic DMARD. Among children without systemic arthritis, methotrexate use was most strongly associated with uveitis (OR 5.2, 95% CI 3.6–7.6), anticitrullinated protein antibodies (OR 4.5, 95% CI 1.7–12), and extended oligoarthritis (OR 4.1, 95% CI 2.5–6.6). Among children without systemic arthritis, biologic DMARD use was most strongly associated with rheumatoid factor (RF)-positive polyarthritis (OR 4.3, 95% CI 2.9–6.6), psoriatic arthritis (PsA; OR 3.0, 95% CI 2.0–4.4), and uveitis (OR 2.8, 95% CI 2.1–3.7). Among children with systemic arthritis, 160 (65%) ever received a biologic DMARD; tumor necrosis factor inhibitor use was associated with polyarthritis (OR 2.5, 95% CI 3.8–16), while interleukin 1 inhibitor use was not.Conclusion.About three-quarters of all children with JIA in the CARRA Registry received nonbiologic DMARD. Nearly one-half received biologic DMARD, and their use was strongly associated with RF-positive polyarthritis, PsA, uveitis, and systemic arthritis.

scholarly journals Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis

2017 ◽  
Vol 76 (6) ◽  
pp. 1113-1136 ◽  
Author(s):  
Jackie L Nam ◽  
Kaoru Takase-Minegishi ◽  
Sofia Ramiro ◽  
Katerina Chatzidionysiou ◽  
Josef S Smolen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Literature Review ◽  
Clinical Response ◽  
Dose Reduction ◽  
Systematic Literature Review ◽  
Phase Iii ◽  
Treat To Target ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Disease Modifying

ObjectivesTo update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform European League Against Rheumatism (EULAR) Task Force treatment recommendations.MethodsMEDLINE, EMBASE and Cochrane databases were searched for phase III or IV (or phase II, if these studies were lacking) randomised controlled trials (RCTs) published between January 2013 and February 2016. Abstracts from the American College of Rheumatology and EULAR conferences were obtained.ResultsThe RCTs confirmed greater efficacy with a bDMARD+conventional synthetic DMARD (csDMARD) versus a csDMARDs alone (level 1A evidence). Using a treat-to-target strategy approach, commencing and escalating csDMARD therapy and adding a bDMARD in cases of non-response, is an effective approach (1B). If a bDMARD had failed, improvements in clinical response were seen on switching to another bDMARD (1A), but no clear advantage was seen for switching to an agent with another mode of action. Maintenance of clinical response in patients in remission or low disease activity was best when continuing rather than stopping a bDMARD, but bDMARD dose reduction or ‘spacing’ was possible, with a substantial proportion of patients achieving bDMARD-free remission (2B). RCTs have also demonstrated efficacy of several new bDMARDs and biosimilar DMARDs (1B).ConclusionsThis systematic literature review consistently confirmed the previously reported efficacy of bDMARDs in RA and provided additional information on bDMARD switching and dose reduction.

Impact of disease modifying anti-rheumatic drugs (DMARDs) on the uveitis risk in juvenile idiopathic arthritis

2015 ◽  
Vol 93 ◽  
pp. n/a-n/a
Author(s):  
C. Tappeiner ◽  
J. Klotsche ◽  
S. Schenck ◽  
M. Niewerth ◽  
K. Minden ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Modifying

scholarly journals The Question of Whether to Remain on Therapy for Chronic Rheumatic Diseases in the Setting of the Covid-19 Pandemic

2020 ◽  
pp. jrheum.200492 ◽  
Author(s):  
Randy Q. Cron ◽  
W. Winn Chatham
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Rheumatic Diseases ◽  
Pediatric Rheumatology ◽  
Cytokine Storm ◽  
Disease Modifying ◽  
Rheumatic Drug ◽  
Chronic Rheumatic Diseases

We appreciate our Italian colleagues’ interest in our editorial denoting the rheumatologist’s role in helping to diagnose and treat cytokine storm syndrome (CSS) in the setting of the Covid-19 panemic (1). It is encouraging that none of the 123 pediatric rheumatology patients (primarily juvenile idiopathic arthritis) on background biological disease modifying anti-rheumatic drug (bDMARD) therapies in Milan, Italy surveyed over a 7-week period from February 25 through April 14, 2020 (during which time Covid-19 was hyper-endemic there) had either confirmed or suspected Covid-19 (2).

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