The following is a summary of “Biologics with or without methotrexate in treatment of polyarticular juvenile idiopathic arthritis: effectiveness, safety and drug survival,” published in the June 2023 issue of Rheumatology by Thiele, et al.

For a study, researchers sought to assess the impact of adding methotrexate (MTX) to biologic treatment in patients with polyarticular juvenile idiopathic arthritis (JIA) regarding treatment effectiveness, safety, and drug survival.

Patients with polyarticular JIA receiving either monotherapy with a first biologic or a combination of a biologic and MTX were selected from the BIKER registry. The study included TNF-α inhibitors (TNFi) adalimumab, etanercept, and golimumab, as well as the IL-6 inhibitor tocilizumab. Using a non-randomized study design, the researchers used propensity score matching to adjust the different cohorts to improve comparability.

The analysis included 2,148 patients, with 1,464 patients in the combination therapy group and 684 in the monotherapy group. Patients receiving combination therapy showed a significantly greater decline in disease activity than biologic monotherapy patients. After adjusting for confounding factors, it was observed that patients treated with TNFi benefitted more from adding MTX than those treated with tocilizumab. Additionally, the median survival time on biologic therapy was significantly longer for patients on combination therapy (3.1 years) compared to monotherapy (2.7 years), as shown by a Kaplan–Meier analysis (log-rank test: P = 0.002). The safety profile was moderately affected by the addition of MTX, resulting in a higher incidence of gastrointestinal and hepatic adverse events. However, the rate of serious adverse events was similar in both cohorts, at 3.6 events per 100 patient years.

The study findings suggested that adding MTX to biologic treatment improved treatment effectiveness in polyarticular JIA without significantly compromising treatment safety. Particularly, TNFi therapies benefited from the combination with MTX, while no significant improvement in treatment outcome has been observed with the combination of tocilizumab and MTX.

Source: academic.oup.com/rheumatology/article-abstract/62/6/2230/6759364?redirectedFrom=fulltext