Universität zu Köln

Klotsche, Jens, Klein, Ariane, Niewerth, Martina, Hoff, Paula, Windschall, Daniel, Foeldvari, Ivan, Haas, Johannes-Peter, Horneff, Gerd and Minden, Kirsten (2021). Re-treatment with etanercept is as effective as the initial firstline treatment in patients with juvenile idiopathic arthritis. Arthritis Res. Ther., 23 (1). LONDON: BMC. ISSN 1478-6362

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Abstract

ObjectivesTo 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.MethodsData 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).ResultsA 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 6months 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 12.1months. 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 12months after restarting ETA.ConclusionThe 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Klotsche, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Klein, Ariane UNSPECIFIED UNSPECIFIED UNSPECIFIED Niewerth, Martina UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoff, Paula UNSPECIFIED UNSPECIFIED UNSPECIFIED Windschall, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Foeldvari, Ivan UNSPECIFIED UNSPECIFIED UNSPECIFIED Haas, Johannes-Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Horneff, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Minden, Kirsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-594907
DOI:	10.1186/s13075-021-02492-0
Journal or Publication Title:	Arthritis Res. Ther.
Volume:	23
Number:	1
Date:	2021
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1478-6362
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HEALTH ASSESSMENT QUESTIONNAIRE; RHEUMATOID-ARTHRITIS; THERAPEUTIC WINDOW; CLINICAL REMISSION; TREATMENT RESPONSE; CHILDREN; SAFETY; EFFICACY; JIA; OPPORTUNITY Multiple languages Rheumatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59490