Biologic therapies for refractory juvenile dermatomyositis: five years of experience of the Childhood Arthritis and Rheumatology Research Alliance in North America

• Type of Material: Article
• Authors: CH Spencer, Nationwide Childrens Hospital; Kelly Rouster Stevens, Emory University; H Gewanter, Pediatric & Adolescent Health Partners; G Syverson, University of Wisconsin; R Modica, University of Florida; K Schmidt, University of Louisville; H Emery, University of Washington; C Wallace, University of Washington; S Grevich, University of Washington; K Nanda, University of Washington; YD Zhao, University of Washington; S Shenoi, University of Washington; S Tarvin, Indiana University; S Hong, University of Iowa; C Lindsley, University of Kansas; JE Weiss, Hackensack University; M Passo, Univ South Carolina; K Ede, Phoenix Childrens Hosp; A Brown, Texas Childrens Hosp; K Ardalan, Lurie Childrens Hosp; W Bernal, University of California San Francisco; ML Stoll, University of Alabama Birmingham; B Lang, WK Health Center; R Carrasco, Dell Children's Hospital; C Agaiar, Childrens Hosp Kings Daughter; L Feller, Inland Rheumatol; H Bukulmez, Metro Health Medical Center; R Vehe, University of Minnesota; H Kim, National Institutes of Health; H Schmeling, University of Calgary; D Gerstbacher, Stanford University; M Hoeltzel, University of Michigan; B Eberhard, Cohen Children's Medical Center; R Sundel, Boston Children's Hospital; S Kim, University of California San Francisco; AM Huber, WK Health Center; A Patwardhan, University of Missouri
• Language: English
• Date: 2017-06-13
• Publisher: BIOMED CENTRAL LTD
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2017
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12969-017-0174-0
• Title of Journal or Parent Work: PEDIATRIC RHEUMATOLOGY
• Volume: 15
• Issue: 1
• Start Page: 50
• End Page: 50
• Grant/Funding Information: The authors wish to acknowledge CARRA, and the ongoing Arthritis Foundation financial support of CARRA.
• Keywords: MULTICENTER; ETANERCEPT; DISEASE; Pediatrics; MYOSITIS; Rheumatology; IDIOPATHIC INFLAMMATORY MYOPATHIES; CALCINOSIS; CONSENSUS CONFERENCE; TERM-FOLLOW-UP; Science & Technology; CHILDREN; ADULT POLYMYOSITIS; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Anatomy

Abstract

Background: The prognosis of children with juvenile dermatomyositis (JDM) has improved remarkably since the 1960's with the use of corticosteroid and immunosuppressive therapy. Yet there remain a minority of children who have refractory disease. Since 2003 the sporadic use of biologics (genetically-engineered proteins that usually are derived from human genes) for inflammatory myositis has been reported. In 2011-2016 we investigated our collective experience of biologics in JDM through the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Methods: The JDM biologic study group developed a survey on the CARRA member experience using biologics for Juvenile DM utilizing Delphi consensus methods in 2011-2012. The survey was completed online by the CARRA members interested in JDM in 2012. A second survey was similarly developed that provided more opportunity to describe their experiences with biologics in JDM in detail and was completed by CARRA members in Feb 2013. During three CARRA meetings in 2013-2015, nominal group techniques were used for achieving consensus on the current choices of biologic drugs. A final survey was performed at the 2016 CARRA meeting. Results: One hundred and five of a potential 231 pediatric rheumatologists (42%) responded to the first survey in 2012. Thirty-five of 90 had never used a biologic for Juvenile DM at that time. Fifty-five of 91 (denominators vary) had used biologics for JDM in their practice with 32%, 5%, and 4% using rituximab, etanercept, and infliximab, respectively, and 17% having used more than one of the three drugs. Ten percent used a biologic as monotherapy, 19% a biologic in combination with methotrexate (mtx), 52% a biologic in combination with mtx and corticosteroids, 42% a combination of a biologic, mtx, corticosteroids (steroids), and an immunosuppressive drug, and 43% a combination of a biologic, IVIG and mtx. The results of the second survey supported these findings in considerably more detail with multiple combinations of drugs used with biologics and supported the use of rituximab, abatacept, anti-TNFα drugs, and tocilizumab in that order. One hundred percent recommended that CARRA continue studying biologics for JDM. The CARRA meeting survey in 2016 again supported the study and use of these four biologic drug groups. Conclusions: Our CARRA JDM biologic work group developed and performed three surveys demonstrating that pediatric rheumatologists in North America have been using multiple biologics for refractory JDM in numerous scenarios from 2011 to 2016. These survey results and our consensus meetings determined our choice of four biologic therapies (rituximab, abatacept, tocilizumab and anti-TNFα drugs) to consider for refractory JDM treatment when indicated and to evaluate for comparative effectiveness and safety in the future. Significance and Innovations This is the first report that provides a substantial clinical experience of a large group of pediatric rheumatologists with biologics for refractory JDM over five years.