Different Regimens but Equal Outcomes in Polyarticular JIA Save

CARRA (Childhood Arthritis and Rheumatology Research Alliance) has compared 3 different treatment strategies for polyarticular JIA to identify the optimal time to biologic regimen.

This prospective observational study used data from the STOP-JIA trial (Start Time Optimization of Biologics in Polyarticular JIA) researchers compared the effectiveness of 3 regimens using the primary outcome of clinically inactive disease according to the provisional American College of Rheumatology (ACR) criteria, without glucocorticoids, at 12 months.

1. step-up plan (initial nonbiologic disease-modifying antirheumatic drug [DMARD] monotherapy, adding a biologic if needed
2. early combination plan (DMARD and biologic started together)
3. biologic first plan (biologic monotherapy). . Secondary outcome measures included Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and mobility scores, inactive disease as defined by the clinical Juvenile Arthritis Disease Activity Score in 10 joints (JADAS-10), and the ACR Pediatric 70 criteria (Pedi 70).

From a total of 400 poly JIA patients - 1) 257 (64%) began the step-up plan, 2) 100 (25%) the early combination plan, and 3) 43 (11%) the biologic first plan.

After propensity score corrections the rate of clinically inactive disease was -

1. Step- up Plan 32%
2. Early Combo plan 37%
3. Biologic first plan 24% (P = 0.17)

Patients in the early combination plan were more likely to achieve Inactive disease (JADAS-10 score ≤2.5) than the step-up plan (59% versus 43%; P = 0.03), as well as ACR Pedi 70 (81% versus 62%; P = 0.008).

The ability to achieve clinically inactive disease without glucocorticoids did not significantly differ between groups at 12 months. This likely reflects the initation of early interventions known to be effective in poly JIA.