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Paediatric rheumatology
Treat-to-target study for improved outcome in polyarticular juvenile idiopathic arthritis
  1. Ariane Klein1,2,
  2. Kirsten Minden3,4,
  3. Anton Hospach5,
  4. Ivan Foeldvari6,
  5. Frank Weller-Heinemann7,
  6. Ralf Trauzeddel8,
  7. Hans-Iko Huppertz7,
  8. Gerd Horneff1,2
  1. 1 Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany
  2. 2 Department of Pediatric and Adolescents Medicine, Medical Faculty, Medical faculty, University Hospital of Cologne, Cologne, Germany
  3. 3 Klinik für Innere Medizin mit SP Rheumatologie und Immunologie, Charité Universitätsmedizin Berlin, Berlin, Germany
  4. 4 Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
  5. 5 Paediatrics, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
  6. 6 Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
  7. 7 Department of Pediatrics, Prof.-Hess-Kinderklinik, Bremen, Germany
  8. 8 Pediatrics, Helios Clinics Berlin, Berlin, Germany
  1. Correspondence to Dr Ariane Klein, Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin 53757, Germany; ariane.klein{at}web.de

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.

  • disease activity
  • juvenile idiopathic arthritis
  • treatment

https://doi.org/10.1136/annrheumdis-2019-216843

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors AK and GH analysed the data and wrote the manuscript. All authors: data collection at the respective centres, read and approved the final manuscript.

    • Funding The study received an unrestricted scientific grant from Pfizer.

    • Competing interests AK received congress travel fees from Sobi, Sandoz and ad board honoraria from Celgene. KM received honoraria from Abbvie, Biermann, GSK, Medac, Sanofi, Roche and research support from the German Arthritis Foundation (Deutsche Rheumastiftung). AH received ad board honoraria from Novartis, Chugai-Roche and SOBI. IF has received ad board honoraria from Novartis, Genzyme, Bayer, Lilly, Pfizer, Abbvie, Sanofi and BMS. FW-H has received speaker honorarium from Pfizer, Abbvie, NOVARTIS, Sobi and Roche. H-IH is Secretary General of the German Academy of Pediatrics. GH has received grants and honorary fees from Abbvie, Pfizer, Novartis and Roche/Chugai.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Anonymised participant data will be made available on reasonable request: https://orcid.org/0000-0001-9771-8710.