Clinically Inactive Disease in a Cohort of Children with New-onset Polyarticular Juvenile Idiopathic Arthritis Treated with Early Aggressive Therapy: Time to Achievement, Total Duration, and Predictors
Clinically Inactive Disease in a Cohort of Children with New-onset Polyarticular Juvenile Idiopathic Arthritis Treated with Early Aggressive Therapy: Time to Achievement, Total Duration, and Predictors
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DOI：
10.3899/jrheum.131503
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发表时间：
2014-06-01
影响因子：
3.9
通讯作者：
Lovell, Daniel J.
中科院分区：
文献类型：
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作者：
Wallace, Carol A.;Giannini, Edward H.;Lovell, Daniel J.
Objective.在一组新近发病的多关节型幼年特发性关节炎（poly-JIA）患儿中，确定从接受积极治疗到首次观察到临床非活动性疾病（CID）的时间、CID的总持续时间以及这种反应的潜在预测因素。85名儿童随机盲法接受甲氨蝶呤（MTX）、依那西普和快速减量泼尼松龙（MEP）或MTX单药治疗，并在1年的治疗期间评估CID。未能达到中间终点的患者转为开放标签MEP治疗。85例患者中有58例（68.2%）在1次或多次访视时达到CID，包括18例接受盲法MEP，11例接受MTX单药治疗，29例接受开放标签MEP。与开始MTX治疗的患者相比，开始MEP治疗的患者更早达到CID，CID的研究天数更多，但差异无显著性。在病程早期给予MEP（更积极的治疗）的患者在统计学上更可能比基线时病程较长的患者有更高比例的CID随访。在4个月时达到美国流变学学会儿科70分应答的患者，与未能达到这一改善的患者相比，CID的随访比例显著更高（p < 0.0001）。在32例符合CID标准但随后失去CID状态的患者中，只有3例符合疾病发作的定义。治疗前较短的疾病持续时间、4个月时的稳健反应以及更积极的治疗导致多聚JIA患者发生CID的可能性更高且持续时间更长。获得本分析数据的原始试验在www.clinicaltrials.gov NCT 00443430上注册。
Objective. To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA).Methods. Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment.Results. Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare.Conclusion. Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.