Timing matters: real-world effectiveness of early combination of biologic and conventional synthetic disease-modifying antirheumatic drugs for treating newly diagnosed polyarticular course juvenile idiopathic arthritis

What is it about?

•	What is already known about this subject?

Recent treatment guidelines recommended adaptive treatment strategies admitting bDMARDs at different timing, adaptive to patient’s response. Previous trials suggested early aggressive combination of cs+bDMARDs is more effect than csDMARDs only.

•	What does this study add?

This comparative effectiveness research study compared the early combination cs+bDMARD vs. delayed use of bDMARD in treating children with newly diagnosed pcJIA. The results suggested that early use of bDMARD can effectively reduce disease activity by 6 months of treatment. Adding bDMARD at 6 months provide very little benefit for the 12 months outcome.

The study is novel in the study designs and analytical methods. It took new patient DMARD naïve study design. It applied a novel Bayesian nonparametric causal inference method. Electronic medical records are used to offers real world evidence particularly for evaluating effectiveness of adaptive treatment strategies.

•	How might this impact on clinical practice or future developments

This study suggests timing matters. Early use of bDMARDs is more effective than delayed bDMARDs use in achieving earlier and sustained improvement in treating children with newly diagnosed pcJIA.


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