Comparison of the outcomes between early and late anti-tumor necrosis factor therapy in patients with enthesitis-related subcategory of juvenile idiopathic arthritis: a multi-center study in Southeast Asia

ABSTRACT

Background

Little is known about the impact of delayed initiation of anti-tumor necrosis factor (TNF) therapy in patients with enthesitis-related arthritis (ERA). Here, we compared the impact of delayed treatment on disease outcomes of ERA patients in Southeast Asia.

Research design and methods

This retrospective study enrolled 149 ERA patients from Thailand and Singapore. Early (e-aTNF) and late (l-aTNF) treatment groups received anti-TNF therapy starting at ≤6 months and >6 months, respectively, after diagnosis. Outcomes included mean differences in disease activity parameters, Juvenile Spondyloarthritis Disease Activity (JSpADA) score, Juvenile Arthritis Diseases Activity (JADAS)-10 score, and American College of Rheumatology Pediatric (ACR Pedi) criteria, and the frequency of clinically inactive disease and first flare event.

Results

The mean changes in JSpADA (p = 0.002) and JADAS-10 (p < 0.001) scores over time were significantly higher in the e-aTNF group than in the l-aTNF group. A significantly higher proportion of patients in the e-aTNF group than l-aTNF group satisfied ACR Pedi 100 criteria at 2 years (p = 0.042). All other long-term outcomes were not significantly different between the groups.

Conclusions

Although early anti-TNF treatment improved disease activity parameters somewhat better than delayed anti-TNF therapy, there was no significant difference in long-term outcomes.

KEYWORDS:

• Biologic agent
• efficacy
• juvenile idiopathic arthritis
• long-term outcomes
• enthesitis-related arthritis
• tumor necrosis factor

Ethical approval

This study was approved by the ethics committees of Ramathibodi Hospital and Siriraj Hospital, Mahidol University, and SingHealth Centralized Institute Review Board and conformed to the provisions of the World Medical Association Declaration of Helsinki. The informed consent requirement was waived by the ethics committees of each institution.

Acknowledgments

The authors thank Nattawut Unwanatham and Sasivimol Rattanasiri (Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University) for their assistance with the statistical analysis. The authors also thank Anne M O’Rourke from Edanz Group (www.edanzediting.com/ac) for English language editing. S Vilaiyuk has received the Research Career Development Award from the Faculty of Medicine Ramathibodi Hospital.

Author contributions

S Vilaiyuk and T Arkachaisri contributed to the study conception and design. Data collection and interpretation were performed by S Vilaiyuk, B Lerkvaleekul, J Jino, S Charuvanij, YX Book and T Arkachaisri. Data analysis was done by S Vilaiyuk and T Arkachaisri. The first draft of the manuscript was written by S Vilaiyuk and T Arkachaisri; and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14712598.2022.2105140

Additional information

Funding

This paper was not funded.