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JAK inhibitors in the treatment of adult patients with juvenile idiopathic arthritis: a retrospective monocentric experience
C.B. Chighizola1, M.R. Pellico2, M. Pandolfi3, L. Marelli4, M. Cornalba5, I. Pontikaki6, S. Costi7, M. Gattinara8, A. Marino9, E. Miserocchi10, R. Caporali11
- Department of Clinical Sciences and Community Health, University of Milan, and Paediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy. cecilia.chighizola@unimi.it
- Department of Clinical Sciences and Community Health, University of Milan; Paediatric Rheumatology Unit, and Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan; Paediatric Rheumatology Unit, and Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, and Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan; Paediatric Rheumatology Unit, and Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Paediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Paediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Paediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Paediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
- Department of Ophthalmology, University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan; Paediatric Rheumatology Unit, and Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy.
CER16921
2024 Vol.42, N°5
PI 0974, PF 0982
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PMID: 38530666 [PubMed]
Received: 16/06/2023
Accepted : 11/10/2023
In Press: 26/03/2024
Published: 14/05/2024
Abstract
OBJECTIVES:
This study aims to evaluate the efficacy and safety of JAK inhibitors (JAKi) in a monocentric cohort of adult patients with juvenile idiopathic arthritis (JIA).
METHODS:
Patients attending a rheumatology transition clinic were retrospectively included in case of: i) JIA diagnosis according to current classification criteria (1); ii) age ≥18 years and iii) treatment with JAKi for at least 3 months.
RESULTS:
Seventeen adult patients with JIA were treated with JAKi (as first JAKi, 9 patients (52.9%) received tofacitinib and 8 (47.1%) baricitinib). At 3 months after JAKi initiation, 8 patients (47%) achieved a response and 4 patients (23.5%) achieved disease remission (3 patients with baricitinib and 1 with tofacitinib, 37.5% vs. 16.7%, p=0.294). None of those with systemic JIA and enthesitis-related arthritis obtained remission; the remission rate at 3 months was higher, although not significantly, in the oligoarticular subset compared to the polyarticular subset (37.5% vs. 20%). Patients with ≤1 active joint involvement at JAKi start had a higher remission rate (50% vs. 22.2%). Subjects who achieved remission on JAKi had a significantly lower pre-treatment DAS28-CRP compared to those with still active disease (p=0.010, Mann-Whitney U=4). A pre-treatment DAS28-CRP <3.76 predicted response to JAKi with 100% sensitivity and 84.6% specificity (p=0.023). The remission rate was lower among patients who had been treated with ≥2 biological drugs before JAKi start (9% vs. 66.7%; p=0.05). One patient in concomitant treatment with leflunomide developed severe arterial hypertension.
CONCLUSIONS:
JAKi may represent an effective and safe treatment option for adult JIA patients with low/moderate disease activity, particularly in case of oligoarticular involvement.
