Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis
Objectives To compare real-world effectiveness of two adaptive treatment strategies of disease-modifying antirheumatic drugs (DMARDs) in treating children with newly diagnosed polyarticular course juvenile idiopathic arthritis (pcJIA): early aggressive use of biologic DMARDs (bDMARDs) in combination...
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BMJ Publishing Group
2020-02-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/6/1/e001091.full |
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| author | Hermine I Brunner Chen Chen Yin Zhang Bin Huang Timothy Beukelman Tingting Qiu Michael Seid Dan Lovell Esi M Morgan Michelle Adams Anne Kocsis Melanie Kohlheim Jeff Guo Stephanie Gray Jinzhong Liu Alivia Neace Siva Sivaganisan Stacey Woeste Xiaomeng Yue Janet Zahner |
| author_facet | Hermine I Brunner Chen Chen Yin Zhang Bin Huang Timothy Beukelman Tingting Qiu Michael Seid Dan Lovell Esi M Morgan Michelle Adams Anne Kocsis Melanie Kohlheim Jeff Guo Stephanie Gray Jinzhong Liu Alivia Neace Siva Sivaganisan Stacey Woeste Xiaomeng Yue Janet Zahner |
| author_sort | Hermine I Brunner |
| collection | DOAJ |
| description | Objectives To compare real-world effectiveness of two adaptive treatment strategies of disease-modifying antirheumatic drugs (DMARDs) in treating children with newly diagnosed polyarticular course juvenile idiopathic arthritis (pcJIA): early aggressive use of biologic DMARDs (bDMARDs) in combination with conventional synthetic DMARDs (csDMARDs) versus conservative delayed use of bDMARDs following the initial csDMARD prescription.Methods A single-centre newly diagnosed DMARD-naive pcJIA patient database (n=465) was derived from the electronic medical records between 1 January 2009 and 31 December 2018. The primary study endpoints were clinical Juvenile Arthritis Disease Activity Score (cJADAS) at 6 and 12 months following the first DMARD prescription. The secondary study endpoint was Pediatric Quality of Life Inventory (PedsQL) generic total score at 12 months. Averaged causal treatment effects were assessed using a Bayesian non-parametric casual inference method.Results Both cJADAS and PedsQL improve over time, regardless of the treatment strategies. Compared with the conservative approach, early aggressive approach is more effective in reducing cJADAS (mean −2.17, 95% CI −3.77 to −0.56) by 6 months. Adding bDMARD after 6 months to the initial treatment provides very little added benefit. The averaged treatment effect was 6.35 (95% CI −5.89 to 18.58) improvement in PedsQL at 12 months.Conclusions Timing matters—early aggressive use with bDMARDs is more effective than conservative delayed treatment in lowering disease activity after 6 and 12 months of treatment. |
| format | Article |
| id | doaj-art-cff08d447ed64e06ba54ebffc80da79b |
| institution | OA Journals |
| issn | 2056-5933 |
| language | English |
| publishDate | 2020-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-cff08d447ed64e06ba54ebffc80da79b2025-08-20T01:54:27ZengBMJ Publishing GroupRMD Open2056-59332020-02-016110.1136/rmdopen-2019-001091Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritisHermine I Brunner0Chen Chen1Yin Zhang2Bin Huang3Timothy Beukelman4Tingting Qiu5Michael Seid6Dan Lovell7Esi M Morgan8Michelle AdamsAnne KocsisMelanie KohlheimJeff GuoStephanie GrayJinzhong LiuAlivia NeaceSiva SivaganisanStacey WoesteXiaomeng YueJanet Zahner1 Division of Rheumatology and Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USAMedical School of Nanjing University, Nanjing, Jiangsu Province, People’s Republic of ChinaDivision of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA1 Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China2University of Alabama at Birmingham, Birmingham, AL, United States of AmericaDivision of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USAPulmonary Medicine and Anderson Center for Health Systems Excellence, Cincinnati Children`s Hospital, Cincinnati, Ohio, USADepartment of Pediatrics, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USACenter for Clinical and Translational Research, Seattle Children`s Research Institute, Seattle, Washington, USAObjectives To compare real-world effectiveness of two adaptive treatment strategies of disease-modifying antirheumatic drugs (DMARDs) in treating children with newly diagnosed polyarticular course juvenile idiopathic arthritis (pcJIA): early aggressive use of biologic DMARDs (bDMARDs) in combination with conventional synthetic DMARDs (csDMARDs) versus conservative delayed use of bDMARDs following the initial csDMARD prescription.Methods A single-centre newly diagnosed DMARD-naive pcJIA patient database (n=465) was derived from the electronic medical records between 1 January 2009 and 31 December 2018. The primary study endpoints were clinical Juvenile Arthritis Disease Activity Score (cJADAS) at 6 and 12 months following the first DMARD prescription. The secondary study endpoint was Pediatric Quality of Life Inventory (PedsQL) generic total score at 12 months. Averaged causal treatment effects were assessed using a Bayesian non-parametric casual inference method.Results Both cJADAS and PedsQL improve over time, regardless of the treatment strategies. Compared with the conservative approach, early aggressive approach is more effective in reducing cJADAS (mean −2.17, 95% CI −3.77 to −0.56) by 6 months. Adding bDMARD after 6 months to the initial treatment provides very little added benefit. The averaged treatment effect was 6.35 (95% CI −5.89 to 18.58) improvement in PedsQL at 12 months.Conclusions Timing matters—early aggressive use with bDMARDs is more effective than conservative delayed treatment in lowering disease activity after 6 and 12 months of treatment.https://rmdopen.bmj.com/content/6/1/e001091.full |
| spellingShingle | Hermine I Brunner Chen Chen Yin Zhang Bin Huang Timothy Beukelman Tingting Qiu Michael Seid Dan Lovell Esi M Morgan Michelle Adams Anne Kocsis Melanie Kohlheim Jeff Guo Stephanie Gray Jinzhong Liu Alivia Neace Siva Sivaganisan Stacey Woeste Xiaomeng Yue Janet Zahner Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis RMD Open |
| title | Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis |
| title_full | Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis |
| title_fullStr | Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis |
| title_full_unstemmed | Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis |
| title_short | Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis |
| title_sort | timing matters real world effectiveness of early combination of biologic and conventional synthetic disease modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis |
| url | https://rmdopen.bmj.com/content/6/1/e001091.full |
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