BackgroundTumor necrosis factor inhibitors are highly effective and safe in treatment of juvenile idiopathic arthritis (JIA). Nonetheless, to select the optimal therapy and to achieve maximum therapeutic effect it is necessary to consider the individual characteristics of the patient. Adalimumab (ADA) is widespread use for mild and severe polyarticular JIA especially in the presence of uveitis, but there is lack of data about clinical and laboratory predictors of response to ADA in different JIA categories.ObjectivesTo identify clinical and laboratory parameters associated with response to adalimumab treatment in 12 months in patients with different JIA category.MethodsAnalysis include patients with enthesitis-related arthritis (ERA, n=56), RF-negative polyarthritis (polyRF-, n=50), extended oligoarthritis (extOligo, n=30), and persistent oligoarthritis (persOligo, n=62) with median age 10.5 (IQR 7–14) and median JADAS-71 19.5 (IQR 15–28). Patients were divided to response groups after 12 month treatment with ADA according to ACRPedi criteria, achieving inactive disease by Wallace criteria and JADAS-71 cut-off point as excellent, intermediate and poor responders. For each of JIA category univariate and multivariate logistic regression analysis was conducted to identify potential baseline factors associated with treatment response. Baseline factors included clinical, laboratory and anamnestic data.ResultsADA was shown to be effective in all groups with 90%/89%/82%/63% children with ACR30/50/70/90 during one year therapy. The most significant factors (p<0.05) associated with response to ADA treatment are presented in summarized table.Table 1FactorsExcellent response to ADAPoor response to ADA CHAQ scorelower at start of ADA (ExtOligo)–VAS disease activity by patient/parenthigher at start of ADA (ERA)lower at start of ADA (ERA)VAS disease activity by physician–lower at start of ADA (PersOligo)Need for corticosteroid eye drops (for uveitis patients)Absence in anamnesis (PersOligo)–Morning stiffnessShorter at start of ADA (ERA), longer at start of ADA (PersOligo)–Joints with active arthritis–higher at start of ADA (PolyRF-)erythrocyte sedimentation rate (ESR)–lower at start of ADA (PolyRF-)Our findings demonstrated that different predictors corresponded with different JIA categories. Interestingly subjective scales of disease activity was shown to be strongly associated with response to therapy. At the same time VAS severity at baseline were inversely correlated with achievement of good response. Duration of morning stiffness correlated with excellent response in children with 2 different categories. However, for ERA patients shorter duration was associated with better response to treatment while vice versa for PersOligo patients.ConclusionsPredictors of response to ADA treatment differ in JIA categories. Low disease activity parameters (clinical and laboratory) at baseline not always predict good response to therapy.Disclosure of InterestE. Kashchenko Grant/research support from: Novartis, E. Alexeeva Grant/research ...
BackgroundChildren with chronic rheumatic diseases, including juvenile idiopathic artritis, are at high risk of bacterial and viral infections. The risk of complications and severity of infectious diseases are increased in immunosuppressive therapy due to given the long-term use.ObjectivesTo evaluate the safety and tolerability of vaccination against pneumococcus in children with juvenile idiopathic arthritis.MethodsThe analysis included 39 patients with juvenile idiopathic arthritis who were in remission. Patients were divided into two groups, depending on the type of immunosuppressive therapy. Group 1 (n=24) consisted of patients receiving etanercept, mean age 5,4±2,5, observed 48 patient-years; Group 2 (n=15), patients who received methotrexate mean age 6,8±3,2, observed 30 patient-years. All patients had been vaccinated by 13-valent pneumococcal polysaccharide conjugate vaccine (13PPV). Recorded the incidence of infection diseases (such as pneumonia, tonsillitis, otitis media, etc.) in the 12 months prior to vaccination and 12 months after vaccination. All patients monitored the development of adverse events against the background of vaccination.ResultsThe study showed a decrease in the incidence ofinfection diseases after vaccination in the first group from 5,4±1,66 to 1,7±0,77, in second group from 4,4±1,05 to 1,6±0 73, (p<0.05). Adverse events related to vaccination are presented in the table. Results of the study showed no relapse of the underlying disease following immunization. Adverse events related to vaccination are presented in the table.Adverse eventsGroup I: MethotrexateGroup II: Etanercept Total, n63Hyperemia and soreness at the injection site32Swelling at the site of vaccine injection11Fever1–Headache1–ConclusionsThe results showed a good tolerability of the vaccine, no relapse of the underlying disease following immunization, as well as a statistically significant (p<0.05) reduction in the incidence following immunization.Disclosure of InterestM. Soloshenko: None declared, E. Alexeeva Grant/research support from: Roche, Abbott, Pfizer, Bristol-Myers Squibb, Centocor, Novartis., Speakers bureau: Roche, Merck Sharp & Dohme, Abbott, Bristol-Myers Squibb, Medac, Novartis, Pfizer, T. Bzarova Grant/research support from: Roche, Pfizer, Speakers bureau: Roche, Merck Sharp & Dohme, Abbott, Pfizer, S. Valieva Grant/research support from: Roche, Bristol-Myers Squibb, Speakers bureau: Roche, Merck Sharp & Dohme, Bristol-Myers Squibb, Medac, Novartis, R. Denisova Grant/research support from: Roche, Centocor, Novartis, Speakers bureau: Roche, Merck Sharp & Dohme, Abbott, Medac, O. Lomakina: None declared, K. Isaeva: None declared, E. Kashchenko Grant/research support from: Novartis, A. Karaseva: None declared
BackgroundAnti-TNF biologics are highly effective and widely used in clinical practice for the treatment of JIA. However, some children lack of response with few reliable predictors of a good or poor response to treatment found [1–3]. As clinical picture patterns are significantly differ for 7 JIA subclasses, we propose to found predictors of response to therapy for each of JIA category.ObjectivesTo identify clinical and laboratory parameters associated with response to etanercept treatment in 12 months in patients with different JIA category.MethodsPatients from four JIA categories (n=195) were divided to groups with excellent, intermediate and poor response after 12 month treatment with etanercept according to ACRPedi criteria, achieving inactive disease by Wallace criteria and JADAS-71 cut-off point. For each of JIA category univariate and multivariate logistic regression analysis was conducted to identify potential baseline factors associated with treatment response. Baseline factors included clinical, laboratory and anamnestic data.ResultsFrom total cohort 91/90/85/68.5 percent of patients achieved ACR30/50/70/90 in one year etanercept treatment; 45.5% patients were considered excellent responders, 30% - intermediate responders, and 24.5% - poor responders. Highest efficacy of therapy was shown in persistent oligoarthritis patient, lowest – in enthesitis-related arthritis and polyarthritis patients. Potential baseline predictors of excellent and poor response which were significant are described in the table.JIA categoryPredictors of excellent responsePredictors of poor response Persistent oligoarthritissmaller amount of DMARD–Extended oligoarthritisshorter disease duration (DD)–Enthesitis-related arthritis–– longer DDRF-negative polyarthritis– smaller number of joints with limited range of motion (LOM)– longer DD– lower CRP level at the baseline– older ADO– younger age at disease onset (ADO)Analysis showed that poor response in all JIA categories was mainly associated with demographic data (longer DD and older ADO). However, factors associated with excellent response significantly differed depending on JIA category (anamnestic factors, number of involved joints, laboratory factors, and demographic factors).ConclusionsResponse to etanercept therapy is strongly associated with JIA category. Shorter disease duration and lower number of DMARDs used before start of etanercept, lower number of joints with LOM, and lower C-reactive protein at baseline are predictors of better response to etanercept.References Otten MH, et al. JAMA 2011;306:2340–7.Kearsley-Fleet L, et al. Rheumatology (Oxford) 2016;55:840–7.Solari N, et al. J Rheumatol 2013;40:192–200. Disclosure of InterestE. Kashchenko Grant/research support from: Novartis, E. Alexeeva Grant/research support from: Roche, Abbott, Pfizer, Bristol-Myers Squibb, Centocor, Novartis, Speakers bureau: Roche, Merck Sharp & Dohme, Abbott, Bristol-Myers Squibb, Medac, Novartis, Pfizer, T. Bzarova Grant/research support from: Roche, Pfizer, Novartis, Speakers bureau: Roche,...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.