Pamela F Weiss1,2, Rui Xiao3,4, Timothy G Brandon3,4, Ilaria Pagnini3,4, Tracey B Wright3,4, Timothy Beukelman3,4, Esi Morgan-DeWitt3,4, Chris Feudtner3,4. 1. From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy. weisspa@email.chop.edu. 2. P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine weisspa@email.chop.edu. 3. From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy. 4. P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine.
Abstract
OBJECTIVE: To characterize the effect of anti-tumor necrosis factor (TNF) therapy compared to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in children with enthesitis-related arthritis (ERA) over the first year after diagnosis. METHODS: We conducted a multicenter retrospective comparative effectiveness study of children diagnosed with ERA. We estimated the effect of anti-TNF therapy on clinical variables (active joint count, tender entheses count) and patient-reported pain and global assessment of disease activity over the first year after diagnosis using state-of-the-art comparative effectiveness analytic methods. RESULTS: During the study period, 217 patients newly diagnosed with ERA had a total of 965 clinic visits the first year after disease diagnosis. Children [median age 11.6 yrs, interquartile range 10-14] were treated with anti-TNF monotherapy (n = 33, 15.2%), csDMARD monotherapy (n = 73, 33.6%), or both (n = 52, 23.9%) in the first year after disease diagnosis. There was a statistically significant improvement in the primary outcome, active joint count, over time in children who received an anti-TNF drug versus those who did not (p = 0.03). Additionally, use of anti-TNF therapy versus no anti-TNF therapy was associated with less patient-reported pain (p < 0.01) and improved disease activity over time as assessed by the clinical Juvenile Arthritis Disease Activity Score (p < 0.01). The magnitude of estimated effect on clinical outcomes was uniformly greater, with the exception of tender entheses count, in children treated with an anti-TNF drug versus a csDMARD. CONCLUSION: During the first year after diagnosis, anti-TNF exposure was associated with benefits for several clinically meaningful outcomes in children with enthesitis-related arthritis.
OBJECTIVE: To characterize the effect of anti-tumor necrosis factor (TNF) therapy compared to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in children with enthesitis-related arthritis (ERA) over the first year after diagnosis. METHODS: We conducted a multicenter retrospective comparative effectiveness study of children diagnosed with ERA. We estimated the effect of anti-TNF therapy on clinical variables (active joint count, tender entheses count) and patient-reported pain and global assessment of disease activity over the first year after diagnosis using state-of-the-art comparative effectiveness analytic methods. RESULTS: During the study period, 217 patients newly diagnosed with ERA had a total of 965 clinic visits the first year after disease diagnosis. Children [median age 11.6 yrs, interquartile range 10-14] were treated with anti-TNF monotherapy (n = 33, 15.2%), csDMARD monotherapy (n = 73, 33.6%), or both (n = 52, 23.9%) in the first year after disease diagnosis. There was a statistically significant improvement in the primary outcome, active joint count, over time in children who received an anti-TNF drug versus those who did not (p = 0.03). Additionally, use of anti-TNF therapy versus no anti-TNF therapy was associated with less patient-reported pain (p < 0.01) and improved disease activity over time as assessed by the clinical Juvenile Arthritis Disease Activity Score (p < 0.01). The magnitude of estimated effect on clinical outcomes was uniformly greater, with the exception of tender entheses count, in children treated with an anti-TNF drug versus a csDMARD. CONCLUSION: During the first year after diagnosis, anti-TNF exposure was associated with benefits for several clinically meaningful outcomes in children with enthesitis-related arthritis.
Authors: Pamela F Weiss; Robert A Colbert; Rui Xiao; Chris Feudtner; Timothy Beukelman; Esi Morgan DeWitt; Ilaria Pagnini; Tracey B Wright; Carol A Wallace Journal: Arthritis Care Res (Hoboken) Date: 2014-12 Impact factor: 4.794
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Authors: Sarah Ringold; Sheila T Angeles-Han; Timothy Beukelman; Daniel Lovell; Carlos A Cuello; Mara L Becker; Robert A Colbert; Brian M Feldman; Polly J Ferguson; Harry Gewanter; Jaime Guzman; Jennifer Horonjeff; Peter A Nigrovic; Michael J Ombrello; Murray H Passo; Matthew L Stoll; C Egla Rabinovich; Rayfel Schneider; Olha Halyabar; Kimberly Hays; Amit Aakash Shah; Nancy Sullivan; Ann Marie Szymanski; Marat Turgunbaev; Amy Turner; James Reston Journal: Arthritis Rheumatol Date: 2019-04-25 Impact factor: 10.995