New Treatments for JIA Needed to Improve Outcomes in Children

There is a great need for additional medications to control the signs and symptoms of juvenile idiopathic arthritis (JIA), despite the availability of several approved biologic disease-modifying antirheumatic drugs, according to new research presented this week at the 2019 ACR/ARP Annual Meeting held in Atlanta, Georgia.

Currently, there are several biologics used for JIA treatment in the United States, including etanercept, adalimumab, abatacept, tocilizumab, and canakinumab. However, many children with JIA continue to have active arthritis despite the available medications. This leads them to be treated with other medications off-label.

The objective of the study was to document the continuing medical need for additional, newly-approved medications to treat children with JIA, since many medications that are proven already safe in adults are not being studied in children.

Researchers reviewed electronic medical record data for 1599 JIA patients treated at Cincinnati Children’s Hospital Medical Center (CCHMC) since 2008 for medication use and disease activity. Additionally, the researchers evaluated 7379 patients with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry for medication use and disease activity at their most recent registry visit.

The study defined “ongoing medication need” as active JIA, despite sequential use of 2 or more biologics. Active JIA was measured on a physician global scale of 0 to 10, with 0 as inactive disease. Patient global assessment scores scaled from 0 to 10, with 0 meaning very well.

Active JIA was defined as a physician assessment score of a 3 or higher, or 3 or more active joints, and a patient global assessment score of 3 or higher. Patients with complete data were assessed for medication failure.

In both data sources, use of biologics were common, and ongoing medication need was assessed in 487 CCHMC patients and 1159 CARRA patients. Fifty-two percent of CCHMC patients and 45% of CARRA patients had ongoing active JIA, despite treatment with 2 or more biologics. There was a frequent use of medications that are not approved for JIA among all of the patients who received any biologic treatment, according to the study.

As more therapies become available for adults, the researchers concluded that testing of these new medications in JIA is essential to further improve disease outcomes in children.

Reference

Schanberg L, Kimura Y, Dennos A, et al. New medications are needed for children with juvenile idiopathic arthritis [abstract]. Arthritis Rheumatology. 2019. https://acrabstracts.org/abstract/new-medications-are-needed-for-children-with-juvenile-idiopathic-arthritis/. Accessed November 13, 2019.