A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis : Initial 3-months results of the BeSt for Kids-study

Autor: R. ten Cate, M. A. J. van Rossum, J.M. van den Berg, L.W.A. van Suijlekom-Smit, P. C. E. Hissink Muller, I. C. J. Brederije, D. M. C. Brinkman, W. P. Bekkering, Y. Koopman-Keemink, Taco W. Kuijpers, D. Schonenberg, Cornelia F Allaart
Přispěvatelé: Pediatrics, AII - Inflammatory diseases, Graduate School, Paediatric Infectious Diseases / Rheumatology / Immunology, ARD - Amsterdam Reproduction and Development, AII - Amsterdam institute for Infection and Immunity, General Paediatrics
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
Arthritis
Administration
Oral
Pediatrics
Treatment strategy study
Etanercept
0302 clinical medicine
Prednisone
Immunology and Allergy
030212 general & internal medicine
Child
skin and connective tissue diseases
Drug Substitution
Perinatology
and Child Health
Multicenter Study
Treatment Outcome
Antirheumatic Agents
Child
Preschool
Randomized Controlled Trial
Drug Therapy
Combination
Female
medicine.drug
musculoskeletal diseases
medicine.medical_specialty
Combination therapy
Injections
Subcutaneous
Short Report
Biologicals
Drug Administration Schedule
03 medical and health sciences
Psoriatic arthritis
Rheumatology
Sulfasalazine
Window of opportunity
Internal medicine
medicine
Journal Article
Humans
Comparative Study
Pediatrics
Perinatology
and Child Health
030203 arthritis & rheumatology
Intention-to-treat analysis
business.industry
Inactive disease
Treat to target
Juvenile idiopathic arthritis
medicine.disease
Arthritis
Juvenile
Methotrexate
Pediatrics
Perinatology and Child Health
Physical therapy
business
Zdroj: Pediatric Rheumatology, 15(1). BioMed Central
Pediatric Rheumatology Online Journal
Pediatric Rheumatology
Pediatric Rheumatology, 15:11. BioMed Central Ltd.
Pediatric rheumatology online journal, 15(1). BioMed Central
Pediatric Rheumatology, 15
ISSN: 1546-0096
Popis: Combination therapy with prednisone or etanercept may induce earlier and/or more improvement in disease activity in Disease Modifying Anti Rheumatic Drug (DMARD) naive non-systemic Juvenile Idiopathic Arthritis (JIA) patients. Here we present three months clinical outcome of initial treatments of the BeSt-for-Kids study. Included patients were randomized to either: 1. initial DMARD-monotherapy (sulfasalazine (SSZ) or methotrexate (MTX)), 2. Initial MTX / prednisolone-bridging, 3. Initial combination MTX/etanercept. Percentage inactive disease, adjusted (a) ACR Pedi30, 50 and 70 and JADAS after 6 and 12 weeks of treatment (intention to treat analysis) and side effects are reported. 94 patients (67% girls, 32 (arm 1), 32 (arm 2) and 30 (arm 3) with median (InterQuartileRange) age of 9.1 (4.7-12.9) years were included. 38% were ANA positive, 10 had oligo-articular disease, 68 polyarticular JIA and 16 psoriatic arthritis. Baseline median (IQR) ACRpedi-scores: VAS physician 49 (40-58) mm, VAS patient 54 (37-70) mm, ESR 6.5 (2-14.8)mm/hr, active joint count 8 (5-12), limited joint count 3 (1-5), CHAQ score 0.88 (0.63-1.5). In arm 1, 17 started with MTX, 15 with SSZ. After 3 months, aACR Pedi 50 was reached by 10/32 (31%), 12/32(38%) and 16/30 (53%) (p = 0.19) and aACR Pedi 70 was reached by 8/32 (25%), 6/32(19%) and 14/30(47%) in arms 1-3 (p = 0.04). Toxicity was similar. Few serious adverse events were reported. After 3 months of treatment in a randomized trial, patients with recent-onset JIA achieved significantly more clinical improvement (aACRPedi70) on initial combination therapy with MTX / etanercept than on initial MTX or SSZ monotherapy. NTR1574 . Registered 3 December 2008.
Databáze: OpenAIRE
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