Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: Time to achievement, total duration, and predictors

Carol A. Wallace, Edward H. Giannini, Steven J. Spalding, Philip J. Hashkes, Kathleen M. O'Neil, Andrew S. Zeft, Ilona S. Szer, Sarah Ringold, Hermine I. Brunner, Laura E. Schanberg, Robert P. Sundel, Diana S. Milojevic, Marilynn G. Punaro, Peter Chira, Beth S. Gottlieb, Gloria C. Higgins, Norman Todd Ilowite, Yukiko Kimura, Anne Johnson, Bin HuangDaniel J. Lovell

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective. To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA). Methods. Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment. Results. Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare. Conclusion. Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.

Original languageEnglish (US)
Pages (from-to)1163-1170
Number of pages8
JournalJournal of Rheumatology
Volume41
Issue number6
DOIs
StatePublished - 2014

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Juvenile Arthritis
Secondary Prevention
Methotrexate
Therapeutics
Prednisolone

Keywords

  • Children 2-16 years
  • Clinical trial
  • Clinically inactive disease
  • Early aggressive therapy
  • Juvenile idiopathic arthritis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Medicine(all)

Cite this

Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy : Time to achievement, total duration, and predictors. / Wallace, Carol A.; Giannini, Edward H.; Spalding, Steven J.; Hashkes, Philip J.; O'Neil, Kathleen M.; Zeft, Andrew S.; Szer, Ilona S.; Ringold, Sarah; Brunner, Hermine I.; Schanberg, Laura E.; Sundel, Robert P.; Milojevic, Diana S.; Punaro, Marilynn G.; Chira, Peter; Gottlieb, Beth S.; Higgins, Gloria C.; Ilowite, Norman Todd; Kimura, Yukiko; Johnson, Anne; Huang, Bin; Lovell, Daniel J.

In: Journal of Rheumatology, Vol. 41, No. 6, 2014, p. 1163-1170.

Research output: Contribution to journalArticle

Wallace, CA, Giannini, EH, Spalding, SJ, Hashkes, PJ, O'Neil, KM, Zeft, AS, Szer, IS, Ringold, S, Brunner, HI, Schanberg, LE, Sundel, RP, Milojevic, DS, Punaro, MG, Chira, P, Gottlieb, BS, Higgins, GC, Ilowite, NT, Kimura, Y, Johnson, A, Huang, B & Lovell, DJ 2014, 'Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: Time to achievement, total duration, and predictors', Journal of Rheumatology, vol. 41, no. 6, pp. 1163-1170. https://doi.org/10.3899/jrheum.131503
Wallace, Carol A. ; Giannini, Edward H. ; Spalding, Steven J. ; Hashkes, Philip J. ; O'Neil, Kathleen M. ; Zeft, Andrew S. ; Szer, Ilona S. ; Ringold, Sarah ; Brunner, Hermine I. ; Schanberg, Laura E. ; Sundel, Robert P. ; Milojevic, Diana S. ; Punaro, Marilynn G. ; Chira, Peter ; Gottlieb, Beth S. ; Higgins, Gloria C. ; Ilowite, Norman Todd ; Kimura, Yukiko ; Johnson, Anne ; Huang, Bin ; Lovell, Daniel J. / Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy : Time to achievement, total duration, and predictors. In: Journal of Rheumatology. 2014 ; Vol. 41, No. 6. pp. 1163-1170.
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abstract = "Objective. To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA). Methods. Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment. Results. Fifty-eight (68.2{\%}) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare. Conclusion. Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.",
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T1 - Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy

T2 - Time to achievement, total duration, and predictors

AU - Wallace, Carol A.

AU - Giannini, Edward H.

AU - Spalding, Steven J.

AU - Hashkes, Philip J.

AU - O'Neil, Kathleen M.

AU - Zeft, Andrew S.

AU - Szer, Ilona S.

AU - Ringold, Sarah

AU - Brunner, Hermine I.

AU - Schanberg, Laura E.

AU - Sundel, Robert P.

AU - Milojevic, Diana S.

AU - Punaro, Marilynn G.

AU - Chira, Peter

AU - Gottlieb, Beth S.

AU - Higgins, Gloria C.

AU - Ilowite, Norman Todd

AU - Kimura, Yukiko

AU - Johnson, Anne

AU - Huang, Bin

AU - Lovell, Daniel J.

PY - 2014

Y1 - 2014

N2 - Objective. To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA). Methods. Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment. Results. Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare. Conclusion. Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.

AB - Objective. To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA). Methods. Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment. Results. Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare. Conclusion. Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.

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KW - Clinical trial

KW - Clinically inactive disease

KW - Early aggressive therapy

KW - Juvenile idiopathic arthritis

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