THU0323
ACHIEVEMENT OF CLINICAL REMISSION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS AFTER A LONG-TERM (2 - 5 YEARS) ETANERCEPT EXPOSURE: A NATIONAL REFERRAL CENTER’S EXPERIENCE. (PRELIMINARY REPORT).
M. Trachana 1,*P. Pratsidou-Gertsi 1G. Pardalos 1
11st Dept Of Pediatrics, Aristotle Univerity, Thessaloniki, Pediatric Immunology and Rheumatology Referral Center, Ippokration Hospital, Thessaloniki, Greece
Background: Published data on the achievement of clinical remission (CR) - which is the ultimate goal of drug efficacy- over a long period of Etanercept (ETN) therapy in JIA patients, are worldwide sparse and completely lacking from Greece.
Objectives: To record the achievement of CR in JIA patients under ETN over a period of 2-5yrs and investigate predictors of CR.
Methods: Data from the 10-year Registry of our Pediatric Referral Center were retrieved. Patients previously resistant to conventional regimen and with a ≥2-year drug exposure were enrolled in the study. The annual impact of ETN on the disease course was assessed by the application of: a) American College of Rheumatology pediatric criteria (ACRpedi), b) the pre- and post-treatment disease activity score (Juvenile Arthritis Disease Activity Score [JADAS71]) and c) Wallace’s criteria for CR.
Results: 41pts (F: M 32:9) were enrolled in the study. Their median age at the time of the ETN dose was 10.6 yrs and their disease course was mainly polyarthritis (32/41). The median disease duration prior to study entry was 4.17 years. One of the pts received ETN for 2 different periods, 24 and 48 mo respectively, thus the annual number of ETN receivers were 42/42/29/20 and 13 from Year 1 to 5, respectively. The annual scores of ACRpedi 30/50/70/90/100 and the number of CR achievers are shown in Table 1. JADAS0 (baseline) did not correlate well with the subsequent achievement of CR. However, JADAS1 (1st year post-treatment) had a significant correlation with CR2 (2nd year post-treatment, p=0.002, ROC/AUC 0.81) and a similar trend was observed for the following treatment years.
Table1. Efficacy of Etanercept over the 5-year study period
|
|
ACRpedi
|
Clinical Remission | |||||
|
|
No of ETN receivers |
<30 |
30 |
50 |
70 |
90 |
100 |
No of pts (%) |
|
Year 1 |
42 |
0 |
4 |
8 |
6 |
7 |
17 |
21 (50.00) |
|
Year 2 |
42 |
1 |
2 |
4 |
9 |
7 |
19 |
24 (54.14) |
|
Year 3 |
29 |
1 |
3 |
3 |
5 |
6 |
11 |
15 (51.72) |
|
Year 4 |
18 |
1 |
2 |
3 |
1 |
2 |
9 |
10 (55.76) |
|
Year 5 |
13 |
2 |
1 |
1 |
0 |
4 |
5 |
8 (61.54) |
Conclusions: These preliminary findings emphasize the impact of ETN in the achievement of CR overtime, as ≥ 50% of pts had achieved CR and sustained it over the 5-year period. There was a strong probability that a low JADAS score 1 year post-treatment, can predict the maintenance of CR over the next year(s) of treatment.
References: 1.Consolaro A, Ruperto N, Bazso A et al. Development and Validation of a Composite Disease Activity Score for Juvenile Idiopathic Arthritis. Arthritis Rheum 2009; 61: 658–66. 2. Ringold S, Wallace CA. Measuring clinical response and remission in juvenile idiopathic arthritis. Curr Opin Rheumatol 2007; 19:471–6.
Disclosure of Interest: M. Trachana Grant / Research support from: Abbott, Novartis and PfizerP. Pratsidou-Gertsi Grant / Research support from: Abbott, Novartis and PfizerG. Pardalos Grant / Research support from: Novartis. This study was funded by Pfizer