Pilot study comparing the Childhood Arthritis & Rheumatology Research Alliance (CARRA) systemic Juvenile Idiopathic Arthritis Consensus Treatment Plans.

2017

23

2017 Apr 11

1546-0096

<p><strong>OBJECTIVES: </strong>To assess the feasibility of studying the comparative effectiveness of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans (CTPs) for systemic Juvenile Idiopathic Arthritis (JIA) using an observational registry.</p>

<p><strong>METHODS: </strong>Untreated systemic JIA patients enrolled in the CARRA Registry were begun on one of 4 CTPs chosen by the treating physician and patient/family (glucocorticoid [GC] alone; methotrexate [MTX] ± GC; IL1 inhibitor [IL1i] ± GC; IL6 inhibitor [IL6i] ± GC). The primary outcome of clinical inactive disease (CID) without current GC use was assessed at 9&nbsp;months.</p>

<p><strong>TRIAL REGISTRATION: </strong>clinicaltrials.gov NCT01697254; first registered 9/28/12 (retrospectively enrolled).</p>

<p><strong>RESULTS: </strong>Thirty patients were enrolled at 13 sites; eight patients were started on a non-biologic CTP (2 GC, 6 MTX) and 22 patients on a biologic CTP (12 IL1i, 10 IL6i) at disease onset. Demographic and disease features were similar between CTP groups. CTP choice appeared to segregate by site preference. CID off GC was achieved by 37% (11 of 30) including 11/22 (50%) starting a biologic CTP compared to 0/8 starting a non-biologic CTP (p = 0.014). There were four serious adverse events: two infections, one appendicitis and one macrophage activation syndrome.</p>

<p><strong>CONCLUSIONS: </strong>The CARRA systemic JIA CTP pilot study demonstrated successful implementation of CTPs using the CARRA registry infrastructure. Having demonstrated feasibility, a larger study using CTP response to better determine the relative effectiveness of treatments for new-onset systemic JIA is now underway.</p>

10.1186/s12969-017-0157-1

Pediatr Rheumatol Online J

28399931

2013 update of the 2011 American College of Rheumatology recommendations for treatment of juvenile idiopathic arthritis: recommendations for medical therapy of children with systemic JIA and TB screening among children receiving biologic medications.

2013

2499-512

2013 Oct

1529-0131

10.1002/art.38092

Arthritis Rheum.

24092554

Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis.

2012

1001-10

2012 Jul

2151-4658

<p><strong>OBJECTIVE: </strong>There is wide variation in therapeutic approaches to systemic juvenile idiopathic arthritis (JIA) among North American rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available for treatment of systemic JIA can result in better health outcomes. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans and standardized assessment schedules for use in clinical practice to facilitate such studies.</p>

<p><strong>METHODS: </strong>Case-based surveys were administered to CARRA members to identify prevailing treatments for new-onset systemic JIA. A 2-day consensus conference in April 2010 employed modified nominal group technique to formulate preliminary treatment plans and determine important data elements for collection. Followup surveys were employed to refine the plans and assess clinical acceptability.</p>

<p><strong>RESULTS: </strong>The initial case-based survey identified significant variability among current treatment approaches for new-onset systemic JIA, underscoring the utility of standardized plans to evaluate comparative effectiveness. We developed 4 consensus treatment plans for the first 9 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The 4 treatment regimens included glucocorticoids only, or therapy with methotrexate, anakinra, or tocilizumab, with or without glucocorticoids. This approach was approved by &gt;78% of the CARRA membership.</p>

<p><strong>CONCLUSION: </strong>Four standardized treatment plans were developed for new-onset systemic JIA. Coupled with data collection at defined intervals, use of these treatment plans will create the opportunity to evaluate comparative effectiveness in an observational setting to optimize initial management of systemic JIA.</p>

10.1002/acr.21625

Arthritis Care Res (Hoboken)

22290637