FRI0356

CLINICAL REMISSION IN 291 JUVENILE IDIOPATHIC ARTHRITIS PATIENTS TREATED WITH BIOLOGICAL AGENTS

M. Romano ^1,*I. Pontikaki ²M. Gattinara ²I. Ardoino ³P. Boracchi ³P. L. Meroni ^{4 5}V. Gerloni ⁶

¹Pediatric Rheumatology Un, ²Pediatric Rheumatology Unit, Ist. G. Pini, ³Statistica Medica, ⁴Rheumatology, Università degli Studi , ⁵Rheumatology, ⁶Pediatric Rheumatology Uniti, Ist. G. Pini, Milano, Italy

Objectives: determine response to biological therapy (BT) in Juvenile Idiopathic Arthritis (JIA) pts in term of clinical remission on medication (CRM) according to Wallace criteria, and to identify baseline factors  predictors of CRM, in a 10-year experience in a single centre

Methods: In our Pediatric Rheumatology Unit, each pt enrolled in BT is prospectively assessed at start of treatment and then every 3 mo for evaluation of safety and efficacy according to ACRpedi30 criteria. All clinical charts of JIA pts who started BT between Nov'99 and Jul'10 has been retrospectively reviewed to characterize disease activity by applying definition of inactive disease (ID), clinical remission on medication (CRM), clinical remission off medication (CR) according to Wallace criteria

Results: 301 JIA pts, non-responders or intolerant to DMARDs and treated with one or more BT, were identified. Median disease duration, from onset to the beginning of 1st BT, was 7.9 yrs (mean 9.7; range 0.2-41.4). Out of 301 enrolled pts, 291 were eligible for end point of interest. 72.1% were female. According to ILAR criteria, 131 had oligoarthritis (47 persistent  and 84 extended), 58 polyarthritis RF neg, 25 polyarthritis RF pos, 50 systemic disease, 17 Enthesitis Related Arthritis and 10 psoriatic arthritis. Median age at onset was 5.2 yrs (mean 6.7; range 0.5-16.8). In total 569 cycles of BT (490 anti-TNF, 79 anti-cytokines and anti-cells treatments) were done. Mean n° of BT cycles for each pt was 1.9 (range 1-8). Considering only 1st cycle of BT, at last observation, 134 pts obtained at least one period of CRM of variable duration. Only 4 pts reached CR and 6 pts reached CR off BT, continuing only DMARDs. Median treatment duration to reach the CRM was 12 mo. CRM was achieved in 169 of 569 treatments. The chance to reach CRM is strictly related to 1st BT course: 134 of 169 successful treatments (78.6%) were 1st BT courses, and 134 of 291 1st BT courses, vs 35 of 298 subsequent BT courses, led to CRM. Multivariate statistical analysis showed that probability of CRM with 1s BT course is not significantly associated with ILAR categories, drug used and age at onset of disease (p>0.05), is positively correlated with male gender (p=0.04), is negatively correlated with disease duration before starting BT (p=0.06). Concomitant administration of DMARDs raised the chance of reaching CRM (p=0.02)

Conclusions: Upon treatment with the 1st biological agent, many children and young JIA pts, non-responders to DMARDs, reached at least one sustained period of CRM, although they had suffered from long-standing, refractory disease. Earlier initiation of therapy and concomitant DMARDs seems increase chance of reaching remission. Nevertheless persistent CR off medication remains a rare event, but according to Wallace criteria, definition of CR is “12 mo of ID after the end of all treatments”, therefore possibility to reach CR depends primarily on when (and if) you decide to stop all efficacious treatments

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Disclosure of Interest: None Declared