The findings have implications for insurance rules that require patients to take a DMARD for a minimum period before initiating biologic therapy.
Receive email when new articles are published onEarly initiation of biologics — within the first 2 months of symptom presentation — appears to have a significant impact on how rapidly patients with improve, according to findings presented on March 18 at the online annual meeting of the Childhood Arthritis and Rheumatology Research Alliance .
Canada and many US states currently require 3 months of DMARD treatment before patients can start a biologic, Twilt said, yet "this study shows the additive benefit of using a biologic within 2 months of starting a DMARD, which hopefully will lead to insurance companies adopting this threshold." Patients in the rapid improvement group achieved inactive disease within 1 year and maintained inactive disease through the second and third years. The moderate and low improvement groups both had higher disease activity at baseline, but the moderate group continued to improve in years 2 and 3, with minimal disease by year 3, on the basis of the cJADAS-10 scores of 2.5-5. The slow group continued to experience moderate disease activity during years 2 and 3.
The researchers also found that not all patients needed biologics to end up in the rapid improvement group. Among patients who never received any biologics during the 3-year period, 19.7% improved rapidly and 10.4% improved moderately. Yet the researchers identified no significant differences in demographics or clinical factors between patients who received biologics and those who did not.
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