Research on SLE, pJIA & More Highlighted in 2nd ACR Convergence 2021 Plenary Session

How SLE Activity Affects Flare Risk after HCQ Maintenance & Discontinuation

Dr. Sasha Bernatsky

Sasha Bernatsky, MD, PhD, James McGill Professor, Department of Medicine, Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, shared data on how baseline SLE disease activity may affect the risk of flare when hydroxychloroquine (HCQ) is stopped or the dose is lowered.⁴ Although HCQ is the cornerstone of SLE treatment, physicians and patients often consider lowering the dose or stopping the drug during remission and low disease activity to limit long-term toxicity. The study was limited by observational methods, but maintaining the HCQ dose had a lower flare risk in most subgroups evaluated.

Dr. Bernatsky concluded, “Safer subgroups for tapering HCQ may exist, and patient preferences should be considered. But given significant flare rates across all groups, we need to keep working on optimizing SLE treatments.”

Start Time of Biologics in Polyarticular JIA

Dr. Yukiko Kimura

Yukiko Kimura, MD, professor of pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Hackensack Meridian School of Medicine, Hackensack, NJ, discussed 24-month outcomes from the STOP-JIA trial.⁵ We know that polyarticular juvenile idiopathic arthritis (pJIA) patients are at risk of poor outcomes, but little evidence currently exists to support a best time to start biologics. STOP-JIA aimed to identify the optimal timing for administration of these agents.

Note: STOP-JIA compared three Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans: 1) step up (SU)—starting a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) and adding a biologic (b)DMARD, if needed, after three or more months; 2) early combination (EC)—csDMARD and bDMARD started together; and 3) biologic first (BF)—starting bDMARD monotherapy, adding a csDMARD, if needed, after three or more months. Data were collected every three months using the CARRA registry for the first 12 months and every six months thereafter. Patients with 24 months of follow-up were included in this analysis. The primary outcome was the proportion of children achieving clinically inactive disease (CID) off glucocorticoids (GC) at 24 months.

Although it was an observational, non-randomized study, the study found a significant difference in CID in the patients who received the early combination compared with the step-up therapy or biologic-first therapy approaches.

“In summary, it’s encouraging that outcomes in all three treatment groups continued to improve at 24 months after starting treatment,” said Dr. Kimura. “However, this data suggests starting biologics early in pJIA may lead to better long-term outcomes, although pJIA still remains a challenging disease to treat. Fortunately, the Childhood Arthritis and Rheumatology Research Alliance [CARRA] registry follow-up will continue for these patients for 10 or more years. So more important data regarding the durability of this response will become available over time.”