Predictors of Clinical Remission in Children With Polyarticular Juvenile Idiopathic Arthritis Treated With Abatacept.

Abstract

To determine whether demographics, clinical measures, and disease activity predict inactive disease (ID) or clinical remission (CR) in patients with polyarticular course-juvenile idiopathic arthritis (pc-JIA) treated with abatacept. Data were extracted from 2 phase III clinical trials in pc-JIA treated with intravenous (age 6-17 years; NCT00095173) and subcutaneous (age 2-17 years; NCT01844518) abatacept. Efficacy endpoints were Juvenile Arthritis Disease Activity Score 10 (JADAS) ID (score ≤2.7) and JADAS CR, (6 consecutive months of JADAS ID based on C-reactive protein [CRP] levels). Time-to-event analyses were performed. Kaplan-Meier analyses estimated time to achieve CR and ID. A total of 347/409 (84.8%) patients were included: 128/190 (67.4%) from the intravenous abatacept trial (excluded: 62 patients who switched to placebo) and 219/219 (100%) from the subcutaneous abatacept trial. In the multivariable model, baseline predictors of JADAS CR (hazard ratio [HR]) included younger age (≤10 years; 1.8), lower CHAQ-DI (≤0.75; 1.8), lower parent global assessment values (≤43.16; 2.1), and normal high-sensitivity CRP (<0.21; 1.6). Patients with minimal disease activity at days 57 or 85 were more likely to achieve both JADAS ID (HR [reference: minimal disease activity] 0.2-0.4 or 0.2-0.5, respectively) and CR (HR [reference: minimal disease activity] 0.1-0.5 or 0-0.3, respectively) earlier than patients with moderate or high disease activity during a 24-month period. Patients who achieve minimal disease activity within 3 months of abatacept treatment are more likely to achieve JADAS ID or CR earlier and maintain it for 24 months, regardless of administration route.