AB0977 Treatment of Patients with Juvenile Idiopathic Arthritis with Abatacept: The South Urals Experience
Authors: G.A. Glazyrina, N. Kolyadina
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Juvenile idiopathic arthritis (JIA) is a severe disease of paediatric population leading to there disability. 524 children with JIA are monitored in Chelyabinsk region. Approximately 15% of patients with inadequate response to methotrexate require treatment with biologics. Among them often Abatacept, an inhibitor of co-stimulation of T-lymphocytes Abatacept, which is registered for use in Russia in children from 6 years, occurs to be the drug of choice. <h3>Objectives</h3> 21 JIA patients (age 6-17 years, mean age 13.4 years, 3 M, 18 F) were included. Disease duration: from 2 to 14 years (mean 6 years). JIA was diagnosed according to ILAR criteria. 6 f with arthritis were RF-positive, RF-negative polyarthritis was reported in 11 children, oligo-arthritis - in 3 children, systemic (without active systemic manifestations) in 1 patient. 6 children had bilateral uveitis. 16 patients had high disease activity. 14 children had III-IV stage of disease on radiographs. All patients II or III class of functional disability. <h3>Methods</h3> All patients were administered 10 mg/kg of Abatacept intravenously according to the scheme: 0-2-4 week and then every 4 weeks. ACR Pedi criteria were used to evaluate the disease activity and treatment efficacy. Statistical evaluation was performed using STATISTICA 6.0 software. Non-parametric methods were used: descriptive statistics, (median, 25-th and 75-th percentiles). Wilcoxon9s criterion was used for assessment of difference in two dependent variables. <h3>Results</h3> All patients had high disease activity before Abatacept initiation. Mean number of joints affected by severe arthritis was 11,8 [4, 20] ([25; 75%]), joints with limited motion - 12,6 [4, 18], mean ESR (as measured by Panchenkov9s method) was 22,8 [15, 28] mm/h, C-RP level - 15,2 [7, 18] g/l. Functional activity index (CHAQ) was 1,3 [0.75; 2.0], disease activity assessed by investigator (VAS) was 65 [50, 70] mm, patient/parents assessment of disease activity (VAS) - 65 [50, 80] mm. Prior to Abatacept treatment, including methotrexate (15 mg/m<sup>2</sup>) for at least 3 months failed to be effective in all children. However, we usually started Abatacept in patients with long-term disease. In two patients Abatacept was the second biological drug after TNF-inhibitors failure, others received Abatacept as the first biological drug. All parents signed informed consent prior to treatment initiation. Treatment with Abatacept occurred to be effective in 19 patients (90%). Clinical remission (ACR pedi criteria ≥90%) was reported in 6 patients within 6-12 months of treatment. Disease activity decreased in 13 patients (ACR pedi criteria 30% in 2 pts, 50% - in 4 and 70% - in 6 pts). We observed improvement of the following signs: mean number of joints affected by severe arthritis decreased to 4,9 [0, 10, joints with limited motion to 7,7 [1, 12], and lowering of mean ESR (9,3 [3, 6] mm/h) and C-RP (5,5 [0, 6.0] g/l) counts. Functional activity index (CHAQ) decreased to 0,625 [0.125; 0,5], disease activity assessed by investigator (VAS) – to 30 [20, 30]. <h3>Conclusions</h3> Treatment of patients with JIA, including uveitis manifestation, Abatacept appeared to be very effective and safe biological treatment. 1/3 of children achieved clinical remission. Disease activity decreased in 90% of patients. Serious adverse event developed only in 1 patient. <h3>Disclosure of Interest</h3> None declared