biologic therapy in children with enthesitis-related arthritis the fist year after disease onset

ABSTRACT Objective. There is scant evidence to guide physicians in the choice of one therapeutic agent or combination over another to treat children and adolescents with enthesites-re lated arthritis (ERA). Clinicians not only need to know about the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) and biologic as stand-alone therapy ver sus placebo, but also how they work in combination and in comparison to one another. The main objective of the study is to characterized the effec tive of biologic exposure in children with ERA over the first year after diagnosis. Methods. We conduced a multicenter retrospective study of children diagnosed with ERA followed in several hospital: Children’s Hospital of Philadelphia, Alabama Children’s Hospital, Cincinnati Children’s Hospital, Texas Scottish Rite Hospital for Children and Meyer Children’s Hospital. We estimated the effect of biologic therapy on clinical pa rameters (active joint count, tender enthesis count, develo pment of sacroiliitis), physician disease activity assessment, and patient-reported pain and global assessment of disease activity over the first year after diagnosis using a weighted repeated measures approach. Results. During the study period, 218 newly diagnosed ERA patients had a total of 968 clinic visits the first year di sease onset. 35 (16.1%), 70 (32.1%) and 56 (25.7%) were treated with biologic, DMARD monotherapy, or both, re spectively during the first year after diagnosis. Over the first year after disease onset, use of a biologic was significantly associated with less pain (p=0.03) and improved disease ac tivity as measured by the JADAS-3 (p=0.02). Use of a bio logic, versus no biologic, was associated with a significant greater negative slope (or faster change over the time) in tender entheses count (p<0.01). Conclusion. During the first year after diagnosis, biologic exposure was associated with benefits for several clinically meaningful outcomes in children with enthesites-related ar thritis