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Open Access 01-12-2017 | Short report

A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months results of the BeSt for Kids-study

Authors: P. C. E. Hissink Muller, D. M. C. Brinkman, D. Schonenberg, Y. Koopman-Keemink, I. C. J. Brederije, W. P. Bekkering, T. W. Kuijpers, M. A. J. van Rossum, L. W. A. van Suijlekom-Smit, J. M. van den Berg, C. F. Allaart, R. ten Cate

Published in: Pediatric Rheumatology | Issue 1/2017

Abstract

Background

Combination therapy with prednisone or etanercept may induce earlier and/or more improvement in disease activity in Disease Modifying Anti Rheumatic Drug (DMARD) naïve non-systemic Juvenile Idiopathic Arthritis (JIA) patients. Here we present three months clinical outcome of initial treatments of the BeSt-for-Kids study.

Methods

Included patients were randomized to either: 1. initial DMARD-monotherapy (sulfasalazine (SSZ) or methotrexate (MTX)), 2. Initial MTX / prednisolone-bridging, 3. Initial combination MTX/etanercept. Percentage inactive disease, adjusted (a) ACR Pedi30, 50 and 70 and JADAS after 6 and 12 weeks of treatment (intention to treat analysis) and side effects are reported.

Results

94 patients (67% girls, 32 (arm 1), 32 (arm 2) and 30 (arm 3) with median (InterQuartileRange) age of 9.1 (4.7-12.9) years were included. 38% were ANA positive, 10 had oligo-articular disease, 68 polyarticular JIA and 16 psoriatic arthritis. Baseline median (IQR) ACRpedi-scores: VAS physician 49 (40-58) mm, VAS patient 54 (37-70) mm, ESR 6.5 (2-14.8)mm/hr, active joint count 8 (5-12), limited joint count 3 (1-5), CHAQ score 0.88 (0.63-1.5). In arm 1, 17 started with MTX, 15 with SSZ.

After 3 months, aACR Pedi 50 was reached by 10/32 (31%), 12/32(38%) and 16/30 (53%) (p = 0.19) and aACR Pedi 70 was reached by 8/32 (25%), 6/32(19%) and 14/30(47%) in arms 1-3 (p = 0.04). Toxicity was similar. Few serious adverse events were reported.

Conclusion

After 3 months of treatment in a randomized trial, patients with recent-onset JIA achieved significantly more clinical improvement (aACRPedi70) on initial combination therapy with MTX / etanercept than on initial MTX or SSZ monotherapy.

Trial registration

NTR1574. Registered 3 December 2008.

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Title: A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months results of the BeSt for Kids-study
Authors: P. C. E. Hissink Muller
D. M. C. Brinkman
D. Schonenberg
Y. Koopman-Keemink
I. C. J. Brederije
W. P. Bekkering
T. W. Kuijpers
M. A. J. van Rossum
L. W. A. van Suijlekom-Smit
J. M. van den Berg
C. F. Allaart
R. ten Cate
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Pediatric Rheumatology / Issue 1/2017
Electronic ISSN: 1546-0096
DOI: https://doi.org/10.1186/s12969-017-0138-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months results of the BeSt for Kids-study

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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