Ringold Sarah, Ong Mei-Sing, Tomlinson George, Natter Marc D, Schanberg Laura E, Del Gaizo Vincent, Feldman Brian M, Murphy Katherine L, Kimura Yukiko
University of Washington, Seattle.
Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts.
Arthritis Rheumatol. 2025 May 8. doi: 10.1002/art.43216.
To assess the impact of differences in the timing of initial biologic disease-modifying antirheumatic drug (bDMARD) therapy using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Start Time Optimization of biologics in Polyarticular Juvenile Idiopathic Arthritis (JIA) (STOP-JIA) - consensus treatment plans study on outcomes through three years.
Start Time Optimization of biologics in Polyarticular-JIA participants with CARRA Registry follow-up through three years were eligible. Outcomes included American College of Rheumatology clinically inactive disease (CID) off glucocorticoids, clinical Juvenile Arthritis Disease Activity Score based on 10 joints inactive disease (cJADAS-10-ID) (cJADAS-10-ID: cJADAS-10 ≤ 2.5), clinical remission on medication (CRM), and proportion of time in CID and/or cJADAS-10-ID. Latent class trajectory modeling (LCTM) was applied to identify participant subgroups sharing similar disease courses over this period.
A total of 297 participants were included (n = 190 step-up [SU], 76 early combination [EC], and 31 biologic first). At the three-year visit, CID was achieved by 35%, 42%, and 44%, respectively (P = 0.35 for SU versus EC). EC was superior to SU in achieving CRM (59.9% vs 40.6%; P = 0.012), time spent in CID (38% versus 30%; P = 0.04), and cJADAS-10-ID (51% versus 41%; P = 0.02). Slow, moderate, and rapid improvement trajectories were identified by LCTM; bDMARD initiation within the first (odds ratio [OR] 5.33) or second (OR 2.67) month from baseline was associated with the rapid improvement trajectory.
EC was superior to SU across three years for outcomes reflecting time spent in lower disease activity. Starting bDMARD within two months predicted rapid improvement and maintenance of inactive disease. These results support the hypothesis that early bDMARD initiation reduces overall disease burden in pJIA.
利用儿童关节炎与风湿病研究联盟（CARRA）多关节型幼年特发性关节炎（JIA）生物制剂起始时间优化（STOP-JIA）——共识治疗计划研究，评估初始生物改善病情抗风湿药物（bDMARD）治疗时机差异对三年结局的影响。
符合条件的是在CARRA注册中心随访三年的多关节型JIA参与者，其生物制剂起始时间得到优化。结局包括美国风湿病学会停用糖皮质激素后的临床无活动疾病（CID）、基于10个关节计算的临床幼年关节炎疾病活动评分无活动疾病（cJADAS-10-ID）（cJADAS-10-ID：cJADAS-10≤2.5）、用药后临床缓解（CRM）以及处于CID和/或cJADAS-10-ID状态的时间比例。应用潜在类别轨迹模型（LCTM）来识别在此期间具有相似疾病进程的参与者亚组。
共纳入297名参与者（n = 190名逐步升级[SU]，76名早期联合[EC]，31名生物制剂优先）。在三年随访时，分别有35%、42%和44%的参与者达到CID（SU与EC相比，P = 0.35）。在实现CRM方面，EC优于SU（59.9%对40.6%；P = 0.012），处于CID状态的时间（38%对30%；P = 0.04）以及cJADAS-10-ID（51%对41%；P = 0.02）。LCTM识别出缓慢、中度和快速改善轨迹；从基线起第一个月（优势比[OR] 5.33）或第二个月（OR 2.67）内开始使用bDMARD与快速改善轨迹相关。
在反映较低疾病活动状态时间的结局方面，EC在三年中优于SU。在两个月内开始使用bDMARD可预测快速改善并维持无活动疾病状态。这些结果支持早期开始使用bDMARD可减轻pJIA总体疾病负担这一假设。
