Etanercept Effective in Re-Treatment of Juvenile Idiopathic Arthritis: Study

ETA is the most commonly prescribed biologic disease-modifying anti-rheumatic drugs (bDMARDs) for the treatment of patients with JIA. Studies have shown that ETA has a good treatment response and good tolerability in patients with JIA. However, scant knowledge exists about the disease course and treatment patterns after discontinuation of the first ETA treatment course. Therefore, Dr Jens Klotsche and his team conducted a study to determine (i) correlates for etanercept (ETA) discontinuation after achieving an inactive disease and for the subsequent risk of flare and (ii) to analyze the effectiveness of ETA in the re-treatment after a disease flare.

The researchers used data from two ongoing prospective registries, BiKeR and JuMBO for the analysis. JUMBO is the follow-up to BIKER and follows participants into adulthood. From both registries, the researchers collected individual trajectories of clinical data and outcomes from childhood to adulthood in JIA patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) and conventional synthetic DMARDs (csDMARDs). They identified 1724 patients with the first ETA course, 338 with the second and 54 with the third ETA course.

Key findings of the study were:

• Upon analysis, the researchers observed similar rates of discontinuation due to ineffectiveness and adverse events in the first (19.4% and 6.2%), second (18.6% and 5.9%), and third (14.8% and 5.6%) ETA course.
• They noted that overall, 332 patients (+/−methotrexate, 19.3%) discontinued ETA after achieving remission with the first ETA course.
• They found that younger age, persistent oligoarthritis, shorter duration between JIA onset and etanercept start, and a good response to therapy within the first 6 months significantly correlated to discontinuation with inactive disease.
• They observed reoccurrence of active disease in 77% of patients with a mean time to flare of 12.1 months. However, they could not identify any factor correlating to flare risk.
• They noted that the majority of patients after flare were re-treated with ETA (n = 117 of 161).
• Among 117 patients, they noted that 23 patients (one in five patients) discontinued the drug again after achieving an inactive disease, while about 70% achieved an inactive disease 12months after restarting etanercept.

The authors concluded, "The study confirms the effectiveness of ETA even for re-treatment of patients with JIA. Our data highlight the association of an early bDMARD treatment with a higher rate of inactive disease indicating a window of opportunity."

For further information:

https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-021-02492-0