Universität zu Köln

Klein, Ariane, Minden, Kirsten, Hospach, Anton, Foeldvari, Ivan, Weller-Heinemann, Frank, Trauzeddel, Ralf, Huppertz, Hans-Iko and Horneff, Gerd (2020). Treat-to-target study for improved outcome in polyarticular juvenile idiopathic arthritis. Ann. Rheum. Dis., 79 (7). S. 969 - 975. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-2060

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Abstract

Background Juvenile idiopathic arthritis is one of the most prevalent chronic inflammatory diseases in children. Evidence suggests that early effective treatment minimises the burden of disease during childhood and in further life. We hypothesise that a guided treat-to-target (T2T) approach is superior to routine care in polyarticular juvenile idiopathic arthritis (pJIA) in terms of reaching a clinical remission after 12 months of treatment. Methods Patients with early and active pJIA were enrolled. Targets for treatment were the following: Recognisable Juvenile Arthritis Disease Activity Score (JADAS) improvement after 3 months, acceptable disease at 6 months, minimal disease activity at 9 months and as primary endpoint remission after 12 months. Initially, patients received methotrexate. Failure to meet a defined target required treatment modification at the specified intervals. The choice of biologics was not influenced by the protocol. Finally, T2T patients were compared with a cohort of matched controls of patients with pJIA with unguided therapy documented by BIKER. Results Sixty-three patients were enrolled. Treatment targets after 3/6/9 and 12 months were reached by 73%/75%/77% and 48% of patients. Fifty-four patients completed the protocol. Compared with matched controls, on T2T guidance significantly more patients reached JADAS remission (48% vs 32%; OR 1.96 (1.1-3.7); p=0.033) and JADAS minimal disease activity (JADAS-MDA) (76% vs 59%; OR 2.2 (1.1-4.4); p=0.028). Patients from the T2T cohort received a biologic significantly more frequent (50% vs 9% after 12 months; OR 9.8 (4.6-20.8); p<0.0001). Conclusion The T2T concept was feasible and superior to unguided treatment. High rates of patients reached JADAS-MDA and JADA remission after 12 months. Approximately half of the patients achieved their therapy goals without a biologic.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Klein, Ariane UNSPECIFIED UNSPECIFIED UNSPECIFIED Minden, Kirsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Hospach, Anton UNSPECIFIED UNSPECIFIED UNSPECIFIED Foeldvari, Ivan UNSPECIFIED UNSPECIFIED UNSPECIFIED Weller-Heinemann, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Trauzeddel, Ralf UNSPECIFIED UNSPECIFIED UNSPECIFIED Huppertz, Hans-Iko UNSPECIFIED UNSPECIFIED UNSPECIFIED Horneff, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-328326
DOI:	10.1136/annrheumdis-2019-216843
Journal or Publication Title:	Ann. Rheum. Dis.
Volume:	79
Number:	7
Page Range:	S. 969 - 975
Date:	2020
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-2060
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DISEASE-ACTIVITY SCORE; THERAPY; RECOMMENDATIONS; ETANERCEPT; PREDICTS; CHILDREN; STATE Multiple languages Rheumatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32832