Biologics with or without methotrexate in treatment of polyarticular juvenile idiopathic arthritis: effectiveness, safety and drug survival

Thiele, Franz; Klein, Ariane; Windschall, Daniel; Dressler, Frank; Kuemmerle‐Deschner, Jasmin; Minden, Kirsten; Foeldvari, Ivan; Foell, Dirk; Mrusek, S.; Oommen, Prasad T.; Horneff, Gerd

doi:10.1093/rheumatology/keac587

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…In previous studies, in contrast with anti-TNFi, no improvement in outcome has been observed by combining TCZ with cDMARD. So, TCZ was identified as being highly effective as a monotherapy (6,23). In this study, TCZ mono-and combination therapies were most commonly preferred for the treatment of RF-polyarticular JIA and JIAassociated uveitis, and were effective and well tolerated.…”

Section: Discussionmentioning

confidence: 92%

Comparison of biologic monotherapy versus biologic and disease-modifying anti-rheumatic drug combination in the treatment of non-systemic juvenile idiopathic arthritis

DEMİRKAN,

AKTAY AYAZ

2023

Türkiye Çocuk Hast Derg

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Purpose To explore the efficacy of biologics as mono- or combination therapy with conventional disease modifying anti-rheumatic drugs (cDMARDs) in the treatment of juvenile idiopathic arthritis (JIA). Material and Methods Medical records of patients with JIA followed-up from January 2020 to 2023 who were treated either with biologic drugs as monotherapy or with combination of cDMARD were reviewed retrospectively. Data of demographic features, clinical scores and treatments were assessed. Results Two hundred five cases received etanercept, adalimumab, or tocilizumab alone or in combination with a cDMARD for JIA were included. The male to female ratio of the cohort was almost equal. Oligoarticular was the most common subtype of JIA. Majority (n=128, 62.4%) of the group received biologic drugs as monotherapy, while the remaining third (n=77, 37.6%) used a combination of biologic and a cDMARD. Nearly half of the group (57.1%) were treated with etanercept and etanercept monotherapy was the most commonly used one among all JIA subtypes except juvenile psoriatic arthritis. Adalimumab combination therapy was prescribed in most of the children with juvenile psoriatic arthritis. Adalimumab, alone or in combination with methotrexate, was preferred for all 8 patients with uveitis at the onset of the disease. Adalimumab combined (n=9) and tocilizumab monotherapy (n=4) were the most common biologics in those who developed uveitis during follow-up. Conclusion Etanercept, adalimumab, or tocilizumab are effective and safe biologics in treatment of JIA. Considering their cost-effective properties, choosing biologic drugs timely as combined or monotherapy is effective in preventing early and late sequelae of JIA.

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Section: Discussionmentioning

confidence: 92%

Comparison of biologic monotherapy versus biologic and disease-modifying anti-rheumatic drug combination in the treatment of non-systemic juvenile idiopathic arthritis

DEMİRKAN,

AKTAY AYAZ

2023

Türkiye Çocuk Hast Derg

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Methotrexate Intolerance in Juvenile Idiopathic Arthritis: Definition, Risks, and Management

Wibrand,

Kyvsgaard,

Herlin

et al. 2024

Pediatr Drugs

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Juvenile idiopathic arthritis is the most common rheumatic disorder in childhood and adolescence posing a significant threat of short-term and long-term disability if left untreated. Methotrexate is a folic acid analog with various immunomodulatory properties. It has demonstrated significant efficacy for the treatment of juvenile idiopathic arthritis, often considered the preferred first-line disease-modifying anti-rheumatic drug given as monotherapy or in combination with biological drugs. Despite this, there is a considerable risk for treatment disruptions owing to the high prevalence of methotrexate intolerance, with symptoms such as nausea, stomach ache, vomiting, and behavioral symptoms. Many different risk factors for the intolerance have been proposed including gender, age, disease activity, treatment duration, dosing and administration, and genetic and psychological factors. As the studies have shown contradictory results, many questions are left unanswered. Therefore, a consensus regarding outcome measures and reporting is crucial. In this review, we describe the identification and assessment of methotrexate intolerance and evaluate potential risk factors, genetic associations as well as management strategies.

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The clinical and experimental treatment of Juvenile Idiopathic Arthritis

Nijhuis

Swart

Prakken

et al. 2023

Clinical and Experimental Immunology

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Summary Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and comprises of multiple subtypes. The most relevant disease subtypes, grouped upon current insight in disease mechanisms, are non-systemic (oligo- and poly-articular) JIA and systemic JIA (sJIA). In this review, we summarize some of the main proposed mechanisms of disease in both non-systemic and sJIA and discuss how current therapeutic modalities target some of the pathogenic immune pathways. Chronic inflammation in non-systemic JIA is the result of a complex interplay between effector and regulatory immune cell subsets, with adaptive immune cells, specifically T cell subsets and antigen presenting cells, in a central role. There is however also innate immune cell contribution. SJIA is nowadays recognized as an acquired chronic inflammatory disorder with striking auto-inflammatory features in the first phase of the disease. Some sJIA patients develop a refractory disease course, with indications for involvement of adaptive immune pathways as well. Currently, therapeutic strategies are directed at suppressing effector mechanisms in both non-systemic and sJIA. These strategies are often not yet optimally tuned nor timed to the known active mechanisms of disease in individual patients in both non-systemic and sJIA. We discuss current treatment strategies in JIA, specifically the ‘Step-up’ and ‘Treat to Target approach’ and explore how increased insight into the biology of disease may translate into future more targeted strategies for this chronic inflammatory disease at relevant time points: pre-clinical disease, active disease and clinically inactive disease.

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Biologics with or without methotrexate in treatment of polyarticular juvenile idiopathic arthritis: effectiveness, safety and drug survival

Cited by 3 publications

References 31 publications

Comparison of biologic monotherapy versus biologic and disease-modifying anti-rheumatic drug combination in the treatment of non-systemic juvenile idiopathic arthritis

Comparison of biologic monotherapy versus biologic and disease-modifying anti-rheumatic drug combination in the treatment of non-systemic juvenile idiopathic arthritis

Methotrexate Intolerance in Juvenile Idiopathic Arthritis: Definition, Risks, and Management

The clinical and experimental treatment of Juvenile Idiopathic Arthritis

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