Treatment escalation patterns to start biologics in refractory moderate juvenile dermatomyositis among members of the Childhood Arthritis and Rheumatology Research Alliance

• DOI: 10.1186/s12969-022-00785-5
• Publication Date: 2023-01-06T16:09:04Z
• Authors: Matthew A. Sherman; Hanna Kim; Katelyn Banschbach; Amanda Brown; Harry L. Gewanter; Bianca Lang; Megan Perron; Angela Byun Robinson; Jacob Spitznagle; Cory Stingl; Grant Syverson; Heather O. Tory; Charles H. Spencer; Stacey E. Tarvin
• Keywords: Juvenile Dermatomyositis; Abatacept; Tocilizumab; Golimumab

Abstract Background Despite new and better treatments for juvenile dermatomyositis (JDM), not all patients with moderate severity disease respond adequately to first-line therapy. Those refractory remain at higher risk glucocorticoid-related complications. Biologic disease-modifying antirheumatic drugs (DMARDs) have become part of the arsenal JDM. However, prospective comparative studies commonly used biologics are lacking. Methods The Childhood Arthritis Rheumatology Research Alliance (CARRA) JDM workgroup met in 2019 produced a survey assessing current treatment escalation practices JDM, including preferences regarding use biologic treatments. cases questions were developed using consensus framework, requiring 80% agreement consensus. was completed online 2020 by CARRA members interested Survey results analyzed among respondents according years experience. Chi-square or Fisher’s exact test compare distribution responses each question. Results One hundred twenty-one responded (denominators vary question). Of respondents, 88% pediatric rheumatologists, 85% practiced United States, 43% had over 10 For patient moderately severe methotrexate, glucocorticoids, IVIG, approximately indicated that they would initiate after failing 1–2 non-biologic DMARDs. Trials methotrexate mycophenolate considered necessary 96% 60% respectively, before initiating biologic. By weighed average, rituximab preferred abatacept, tocilizumab, infliximab. Over 50% start 4 months from diagnosis There no notable differences between Conclusion Most favored starting earlier course trialing up two conventional DMARDs, specifically methotrexate. clear preference rituximab. there remains dearth data comparing These findings underscore need plans (CTPs) which will ultimately facilitate effectiveness inform practices.