Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis§

Authors

  • Esi Morgan Dewitt,

    1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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    • Drs. DeWitt and Kimura contributed equally to this work.

  • Yukiko Kimura,

    Corresponding author
    1. Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
    • Pediatric Rheumatology, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601
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    • Drs. DeWitt and Kimura contributed equally to this work.

    • Dr. Kimura has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Genentech and Novartis.

  • Timothy Beukelman,

    1. University of Alabama at Birmingham
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  • Peter A. Nigrovic,

    1. Children's Hospital, Boston, Massachusetts
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  • Karen Onel,

    1. University of Chicago, Comer Children's Hospital, Chicago, Illinois
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  • Sampath Prahalad,

    1. Emory University, Atlanta, Georgia
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  • Rayfel Schneider,

    1. University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
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    • Dr. Schneider has received consultant and/or speaking fees (less than $10,000 each) from Roche/Hoffman La Roche and Innomar Strategies.

  • Matthew L. Stoll,

    1. University of Alabama at Birmingham
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  • Sheila Angeles-Han,

    1. Emory University, Atlanta, Georgia
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  • Diana Milojevic,

    1. University of California, San Francisco
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    • Dr. Milojevic has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Genentech.

  • Kenneth N. Schikler,

    1. University of Louisville School of Medicine, Louisville, Kentucky
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    • Dr. Schikler owns stock and/or holds stock options in Novartis, Biogen, and Immunogen.

  • Richard K. Vehe,

    1. University of Minnesota, Minneapolis
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  • Jennifer E. Weiss,

    1. Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
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  • Pamela Weiss,

    1. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Norman T. Ilowite,

    1. Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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    • Dr. Ilowite has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Genentech and Abbott Immunology, serves on the advisory board for Genentech and on the Data Safety and Monitoring Board for Novartis and Janssen, and has received drug and placebo from Regeneron for use in an NIH-sponsored clinical trial.

  • Carol A. Wallace,

    1. Seattle Children's Hospital, University of Washington, Seattle
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    • Dr. Wallace owns stock and/or holds stock options in Eli Lilly, has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Genentech, and has received grants from Amgen, Pfizer, and Bristol Myers Squibb.

  • on behalf of the Juvenile Idiopathic Arthritis Disease-specific Research Committee of the Childhood Arthritis Rheumatology and Research Alliance


  • Members of the CARRA Systemic JIA Core Working Group: Esi Morgan DeWitt, Yukiko Kimura, Timothy Beukelman, Peter A. Nigrovic, Karen Onel, Sampath Prahalad, Rayfel Schneider, Matthew L. Stoll, and Joyce Warshawsky.

  • Contributing CARRA Members: T. Brent Graham, Judyann Olson, Judy Smith, James Birmingham, Karen Watanabe Duffy, Edward Fels, Sheila Angeles-Han, Raphael Hirsch, Maria Ibarra, Lisa Imundo, Ginger Janow, Michael Miller, Diana Milojevic, Kabita Nanda, Marc Natter, Nancy Olson, Murray Passo, Michael Rapoff, Sarah Ringold, Tova Ronis, Margalit Rosenkranz, Kenneth N. Schikler, Susan Shenoi, David Sherry, Judith Smith, Steven Spalding, Lynn Spiegel, Tracy Ting, Theresa Wampler-Muskardin, Richard K. Vehe, and Lawrence Zemel.

  • §

    Additional Consensus Meeting Attendees: Patient Representatives Vincent Del Gaizo and Anne Murphy, and CARRA Members Ciaran Duffy, Norman T. Ilowite, Daniel Lovell, Elizabeth Mellins, Michael Rapoff, and Susan Thompson.

Abstract

Objective

There is wide variation in therapeutic approaches to systemic juvenile idiopathic arthritis (JIA) among North American rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available for treatment of systemic JIA can result in better health outcomes. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans and standardized assessment schedules for use in clinical practice to facilitate such studies.

Methods

Case-based surveys were administered to CARRA members to identify prevailing treatments for new-onset systemic JIA. A 2-day consensus conference in April 2010 employed modified nominal group technique to formulate preliminary treatment plans and determine important data elements for collection. Followup surveys were employed to refine the plans and assess clinical acceptability.

Results

The initial case-based survey identified significant variability among current treatment approaches for new-onset systemic JIA, underscoring the utility of standardized plans to evaluate comparative effectiveness. We developed 4 consensus treatment plans for the first 9 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The 4 treatment regimens included glucocorticoids only, or therapy with methotrexate, anakinra, or tocilizumab, with or without glucocorticoids. This approach was approved by >78% of the CARRA membership.

Conclusion

Four standardized treatment plans were developed for new-onset systemic JIA. Coupled with data collection at defined intervals, use of these treatment plans will create the opportunity to evaluate comparative effectiveness in an observational setting to optimize initial management of systemic JIA.

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