SAT0482 TREAT-TO-TARGET STUDY FOR IMPROVED OUTCOME IN POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS
Authors: Gerd Horneff, Joachim Peitz, Ivan Foeldvari, Ralf Trauzeddel, Toni Hospach, Tilmann Kallinich, Frank Weller-Heinemann, Ariane Klein, Kirsten Minden
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Evidence suggests that early effective treatment is important to minimize the burden of Juvenile idiopathic arthritis (JIA). We hypothesize that a guided treat to target (T2T) approach as recommended by the German Society for Pediatric Rheumatology (1) is superior to routine care in polyarticular JIA (pJIA) in terms of reaching minimal disease activity and remission after 12 months of treatment. <h3>Objectives</h3> To assess the clinical benefit in subjects with pJIA treated in compliance with national recommendations measured by rates of patients reaching JADAS remission (≤ 1), JADAS minimal disease activity (MDA) (≤3.8), JADAS acceptable disease status (≤ 5.4). <h3>Methods</h3> After informed consent, patients with early (disease duration ≤ 12 months) and active (JADAS10 &gt; 5.4) pJIA were enrolled. Initially, all patients received methotrexate (MTX). Targets for treatment were defined by the level of improvement and are progressively more rigourous with ongoing treatment. Failure to meet a defined target required treatment modification of specified intervals. The choice of biologic was made by shared decision between the investigator and the patient/parent and not influenced by the protocol. Minimal treatment target defined as recognizable improvement of disease activity (2) was demanded after 3 months, JADAS acceptable disease status at month 6, JADAS MDA at month 9 and JADAS-remission at month 12. T2T Patients were 1:4 matched to a pJIA cohort with unguided therapy documented by the BIKER-registry. <h3>Results</h3> Altogether 62 patients (16 males, 26%) with non-systemic JIA (48/9 RF negative/positive polyarthritis, 3 extended Oligoarthritis, 1 ERA, 1PsA) were included (mean age 9.4+/-4.8 years, disease duration 0.5+/-0.6 years). At month 3; 49 (79%) patients showed JADAS improvement. In 13 (21%) treatment with a biologic was started. At month 6, 45/56 (80%) reached JADAS acceptable disease. In 6 (11%) a biologic agent was started. At month 9, 41/48 (85%) reached JADAS acceptable disease and 38/48 (79%) reached JADAS-MDA. In 4 (10.8%) a biologic was started and two patient switched biologics. So far, 52 patients completed 12 months of observation. 4 patients did not start a biologic although mandatory according to protocol and were excluded. JADAS MDA was reached by 39/48 (81%) and JADAS remission was reached by 22/48 (46%). Compared to the matched control cohort, upon T2T guidance significant more patients reached JADAS MDA (81% vs. 60%; odds 2.9[1.3-6.3]; 0=0.006) and more patients reached JADAS remission (46% vs. 34%; odds 1.6[0.8-3.0]; p=0.15). During the first 12 months of treatment, the T2T approach lead to a significant increase of use of biologics (46% vs. 21%; odds 3.2[1.7-6.3]; p=0.0004). <h3>Conclusion</h3> These data indicate that a T2T concept is feasible and superior. A high rate of patients reached JADAS MDA and JADAS remission after 12 months of treatment. Interestingly, about half of patients did not need to be treated with a biologic to reach predefined T2T (2). Thus, the early treatment escalation seems advantageous indicating a window of opportunity to successfully treat polyarticular JIA. <h3>References</h3> [1] Horneff G, et al. Pediatr Rheumatol Online J. 2017; 15:78 [2] Horneff G et Becker I. Rheumatology. 2014;53:1229-34. <h3>Acknowledgement</h3> The authors acknowledge Pfizer Pharma, Germany for an unrestricted grand <h3>Disclosure of Interests</h3> Gerd Horneff: None declared, Joachim Peitz: None declared, Ivan Foeldvari Consultant for: Chugai, Novartis, Ralf Trauzeddel: None declared, Toni Hospach Speakers bureau: Chugai, Roche, Novartis, Tilmann Kallinich Grant/research support from: Novartis, Speakers bureau: Sobi, Roche, Novartis, CLB, Frank Weller-Heinemann: None declared, Ariane Klein: None declared, Kirsten Minden: None declared