Improved Disease Course Associated With Early Initiation of Biologics in Polyarticular Juvenile Idiopathic Arthritis: Trajectory Analysis of a Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans Study
Improved Disease Course Associated With Early Initiation of Biologics in Polyarticular Juvenile Idiopathic Arthritis: Trajectory Analysis of a Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans Study
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DOI：
10.1002/art.41892
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发表时间：
2021-08-27
影响因子：
13.3
通讯作者：
Natter, Marc D.
中科院分区：
文献类型：
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作者：
Ong, Mei Sing;Ringold, Sarah;Natter, Marc D.
目的探讨早期应用生物性疾病缓解抗风湿药物（bDMARDs）对未治疗的多关节型幼年特发性关节炎（JIA）病程的影响。方法我们分析了参与多关节JIA生物制剂起始时间优化（STOP-JIA）研究的多关节JIA患者（n = 400）和来自儿童关节炎和风湿病研究联盟登记处的对照队列（n = 248）的数据。应用潜在类别轨迹模型（LCTM），根据基线后12个月内的疾病活动（10个关节的临床青少年关节炎疾病活动评分），确定具有不同病程的患者亚组。结果在STOP-JIA研究中，198例（49.5%）受试者在基线评估后3个月内接受了bDMARD治疗。LCTM分析产生了3个潜在类别，代表3种不同的疾病轨迹，其特征在于随着时间的推移缓慢、中度或快速的疾病活动改善。快速改善轨迹中的受试者在自基线起6个月内达到非活动性疾病。在调整人口统计学特征、临床属性和基线疾病活动性后，基线后3个月接受bDMARD治疗的患者处于快速改善轨迹与缓慢改善轨迹的几率是基线后3个月接受bDMARD治疗的患者的3.6倍（95%置信区间1.32-10.0; P = 0.013）。首次风湿病访视时疾病持续时间较短接近统计学显著性，是未接受bDMARD治疗的良好轨迹的预测因子。结论：在基线评估后3个月内开始bDMARD治疗与未经治疗的多关节型JIA受试者更快达到非活动性疾病相关。这些结果证明了疾病过程的轨迹分析作为确定治疗效果的方法的实用性。
Objective To investigate the effects of early introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) on the disease course in untreated polyarticular juvenile idiopathic arthritis (JIA). Methods We analyzed data on patients with polyarticular JIA participating in the Start Time Optimization of Biologics in Polyarticular JIA (STOP-JIA) study (n = 400) and a comparator cohort (n = 248) from the Childhood Arthritis and Rheumatology Research Alliance Registry. Latent class trajectory modeling (LCTM) was applied to identify subgroups of patients with distinct disease courses based on disease activity (clinical Juvenile Arthritis Disease Activity Score in 10 joints) over 12 months from baseline. Results In the STOP-JIA study, 198 subjects (49.5%) received bDMARDs within 3 months of baseline assessment. LCTM analyses generated 3 latent classes representing 3 distinct disease trajectories, characterized by slow, moderate, or rapid disease activity improvement over time. Subjects in the rapid improvement trajectory attained inactive disease within 6 months from baseline. Odds of being in the rapid improvement trajectory versus the slow improvement trajectory were 3.6 times as high (95% confidence interval 1.32-10.0; P = 0.013) for those treated with bDMARDs 3 months after baseline, after adjusting for demographic characteristics, clinical attributes, and baseline disease activity. Shorter disease duration at first rheumatology visit approached statistical significance as a predictor of favorable trajectory without bDMARD treatment. Conclusion Starting bDMARDs within 3 months of baseline assessment is associated with more rapid achievement of inactive disease in subjects with untreated polyarticular JIA. These results demonstrate the utility of trajectory analysis of disease course as a method for determining treatment efficacy.