Early treatment with infliximab — sold under the brand name Remicade, among others — leads to lower inflammation and fewer joints showing active disease over 12 months in children and adolescents with polyarticular idiopathic arthritis (pJIA), a single center study in China suggests.
But to be effective for a full year, treatment soon after disease onset seems essential, its researchers wrote.
Advances in the development and approval of biologic therapies over the last two decades have had a significant impact on the outcome of children with pJIA.
Compared to other disease types, pJIA patients are more likely to fail to respond to initial treatment with disease-modifying anti-rheumatic drugs (DMARDs). But biologic DMARDs have helped to manage disease activity and lessen symptoms.
Infliximab is a biologic DMARD designed to specifically target and block TNF-alpha, a protein that promotes inflammation and is involved in autoimmunity. This type of therapy has shown efficacy in people with pJIA, but differences exist as to an “optimal treatment regimen,” the researches noted.
The team reviewed the long-term impact of treatment with infliximab in 40 children (ages 2 to 13 at diagnosis) with pJIA. All were treated and followed at Children’s
Hospital of Chongqing Medical University over an eight year-period starting in January 2010.
Patients were divided into three groups based on their disease course and when they started on infliximab. Nine (group A) started treatment within three months of disease onset, 13 (group B) between three months and one year of onset, while the remaining 18 (group C) initiated treatment more than one year after disease onset.
All patients were given at least four doses of infliximab (3–6 mg/kg) over three months. Twenty-six received six doses (over six months), and eight patients had nine doses of infliximab, which corresponds to a 12-month treatment period.
Results showed that the erythrocyte sedimentation rate (ESR) — an indicator of active inflammation — was significantly lower in all groups after three and six months of therapy, compared to pre-treatment values. But this benefit, after 12 months, was only maintained in patients with early treatment (group A).
Children in group A were also the only ones to show stable decreases over 12 months in the number of joints with active disease — defined as joints that were tender or painful to move, were swollen, or had limited motion. Also used was the 27-point juvenile arthritis disease activity score (JADAS-27), which includes a physician assessment, a parent/patient global evaluation, ESR rates, and an “active” joint count.
Patients in groups B and C also showed fewer joints with active disease and a lower JADAS-27 score up to six months of treatment, but experienced increases in both assessments at 12 months. These increases were statistically significant when treatment was started more a year after disease onset (group C).
Overall, “infliximab can dramatically improve the outcomes in polyarticular JIA patients, and it should be introduced early during the clinical course,” the team wrote.