“Children are not little adults” is a common refrain in pediatric medicine, but when it comes to a condition like juvenile idiopathic arthritis (JIA), rheumatologists might be better off treating pediatric and adult rheumatic disease more similarly.

A recent study published in Arthritis Care & Research followed children diagnosed with JIA for 18 years. Although not the first long-term study to examine children with JIA, it is unique in that it took place “during a time where biologic DMARDs [disease-modifying antirheumatic drugs] were emerging as a fundamental therapy in the management of children with JIA,” said Dawn M. Wahezi, MD, chief of the division of pediatric rheumatology at the Children’s Hospital at Montefiore in New York, who was not involved with the study.

SrdjanPav/E+/Getty Images

Additionally, the study highlights the International League of Associations for Rheumatology (ILAR) consensus-based classification criteria as an imperfect method to categorize patients with JIA.

Mia Glerup, MD, PhD, of the department of pediatrics at Aarhus (Denmark) University Hospital and colleagues prospectively analyzed 373 patients from Denmark, Norway, Sweden, and Finland with new-onset JIA between 1997 and 2000 and evaluated them at baseline, 8 years, and 18 years. At each visit, the researchers collected data on demographics, disease activity, ILAR category, treatment, and blood samples.

Patients in the cohort were mostly girls (66.7%) with a median age of 5.9 years at onset. Approximately one-third (34.8%) of patients were antinuclear antibody (ANA) positive and 21.6% were HLA-B27 positive. The most common JIA categories at baseline were persistent oligoarthritis (53.9%), polyarticular rheumatoid factor (RF) negative (21.1%), and undifferentiated arthritis (10.2%).

Dr. Glerup and colleagues found that the proportion of patients not receiving DMARDs declined from 73.2% at baseline to 59.7% at 8 years, and then rose again to 70% at 18 years (risk ratio, 1.3; P = .003). The group of 103 patients who used conventional DMARDs (cDMARDs) either as monotherapy or in combination with a biologic DMARD (bDMARD) at 8 years dwindled to 44 (42.7%) at 18 years (RR, 0.4; P < .001), whereas 32 of 52 patients (61.5%) using bDMARDs at 8 years were still taking them at 18 years (RR, 0.6; P = .02). Across the whole study, 14.7% of patients never received any JIA treatment, and 33 of 85 patients (38.8%) on continuous DMARDs developed uveitis during the study period.

Overall, 62.7% of patients received DMARDs at least once, including 89.7% with polyarticular RF negative, 77.3% with oligoarticular extended, 76.9% with systemic, 75.7% with juvenile enthesitis-related arthritis (ERA), 66.7% with polyarticular RF-positive, 65.2% with juvenile psoriatic arthritis (JPsA), 58.9% with undifferentiated JIA, and 27.6% of patients with persistent oligoarticular disease.

The median number of active joints dropped from 3 (range, 1-30) at baseline to 0 at 8 years (range, 0-13), whereas the median cumulative number of affected joints rose from 3 at baseline (range, 1-30) to 6 at 8 years (range, 1-41). At last follow-up, the median number of active joints was 0 (range, 0-5) and median cumulative number of affected joints was 7 (range, 1-47). The percentage of patients in remission barely changed from 52% at 8 years to 51% at 18.

Some patients also changed ILAR categories during the study period, with 7% shifting between baseline and 8 years, and 11% shifting between 8-year and 18-year follow-up. Compared with baseline, by the 18-year follow-up time point there was a significant decrease in the number of patients categorized as oligoarticular (230 vs. 197 patients; P = .02), a significant increase in patients in the psoriatic ILAR category (8 vs. 28 patients; P < .001), and a nonsignificant increase in the number of patients in the undifferentiated category (45 vs. 63 patients; P = .06).

“Almost half of the changes in the distribution between the ILAR categories were caused by updated information on heredity in a first-degree relative obtained at the follow-up visits,” Dr. Glerup and colleagues write.

“That kind of weaves its way through the whole study, because then they show a lot of patients have come off their medication. Patients who had more severe disease in more joints would be less likely, I think, to just stop their medication and stop going to doctors,” Dr. Imundo explained.

Although the study is valuable for its long-term follow-up, there is also a question of generalizability across a more diverse ethnic and racial group. The authors do not elaborate on the racial breakdown of their patients, Dr. Imundo said, “so we’re going to have to assume that the vast majority are going to [have] Caucasian Nordic ethnic background, and that goes along with them having this high percentage of HLA-B27 positivity, which is a gene that’s more prevalent in northern European populations.”

Jonathan Hausmann, MD, a pediatric and adult rheumatologist at Boston Children’s Hospital, Boston,, told this news organization that he believes the overall conclusions from the study – that JIA persists over time and that ILAR classification is a somewhat imprecise measure of assessing JIA types in children – would be generalizable to other groups.

However, long-term registries evaluating JIA in more diverse populations, such as the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry, could confirm these results, said Dr. Hausmann, who is a registry informatics associate with CARRA and was not associated with the research.
 

Long-term management of JIA

In an accompanying editorial, Jaime Guzman, MD, MSc, and Ross E. Petty, MD, PhD, of British Columbia Children’s Hospital and the University of British Columbia, Vancouver, said a rheumatologist’s interpretation of the study would be tied to what they learned about children with arthritis in medical school. They would see the glass as “half full” if children who achieved remission stayed in remission if they learned that a child might end up outgrowing JIA but potentially develop lifelong disability, whereas others may focus on the outcome of approximately half of patients not achieving remission.

“When I was going through medical school, I remember learning that JIA is a disease of children, and typically, they outgrow it as they become adults,” Dr. Hausmann said. “I think this study and many other studies have shown that that’s actually not the case – that, in fact, it may be a majority of kids continue having active disease even through adulthood.”

If a rheumatologist knows JIA is likely to continue into adulthood, “that’s huge,” Dr. Hausmann said. “That means when we first diagnose patients with JIA as kids, we need to set expectations with the families that this may not just go away; this may be something that could be more lifelong.”

Education on the part of the patient, their parents, and their clinician on the expected trajectory of the disease is critical so that children can continue their own care as they transition to adulthood, Dr. Hausmann explained. “The earlier the kids develop the skills to discuss their medicines, their side effects, the better they’ll be able to transition to adult medicine,” he said.

For the patients who go into remission and stay in remission, the message is also important. “To have the reassurance that a lot of those kids won’t be having active joint symptoms or need to be on medication, that’s a huge positive message that can get out there, so I think that’s great,” Dr. Imundo said.
 

Time to move on from ILAR classification?

Another big takeaway from the study was how patients’ ILAR classification changed across the 18-year follow-up. First proposed in 1995, the JIA ILAR classification has been revised several times for clarification purposes. In its current form, the ILAR classification considers a patient’s history when categorizing JIA types but also includes factors such as immediate family history. This system of assessing JIA has been criticized and there are initiatives to create a new JIA classification system to replace it.

“The ILAR criteria were designed to classify patients 6 months after disease onset in an attempt to find some commonality in clinical phenotypes, prognosis, and suggested management,” Dr. Wahezi said. “While there continues to be debate as to whether we can improve our classification of JIA patients, it is not surprising that phenotypes may evolve over time as new clinical features develop. As pediatric rheumatologists, we are well accustomed to having to modify management plans as children manifest with new clinical features over time.”

Although the percentage of patients who switched ILAR classifications over the study period was “much higher” than she would have thought, Dr. Imundo said it was the reasons provided in the study that seemed odd to her. “The classification scheme relies on your family history, like someone else in your family now has psoriasis, so your arthritis classification changes,” she explained.

“We want to head toward a much more unified classification scheme, a simpler one. We now understand that some of the diseases that we see in pediatrics are really the equivalent or same disease in adults,” she said.

“Most of the pediatric categories of JIA have distinct adult correlates,” Dr. Hausmann agreed. RF-positive polyarthritis in children and rheumatoid arthritis in adults are correlated, as are systemic JIA and adult-onset Still’s disease, he explained. “That has been borne out also by genetic susceptibility studies that the genetic predispositions to systemic arthritis in children is the same as the genetic predisposition to adult-onset Still’s disease in adults. By and large, there are a lot of similarities between the two.

“I think we need to incorporate some of that knowledge in better classifying kids with JIA so that we can find the best treatments and the best outcomes, and we can provide information to families about the expected course of the disease over time so that can inform our discussions.”

Some pediatric rheumatologists accept the classification system is flawed, but not all concur with the degree to which these problems impact patient care. “While the ILAR classification criteria may be subject to criticism, it does provide general context and prognostic implications for patients and families,” Dr. Wahezi said.

“The medicines certainly are very similar across the JIA categories, so the implications are not as broad” when classification changes,” Dr. Hausmann said. “But it certainly shows that there are things that we still don’t know. I think classification is actually pretty important because it might give you a sense of how persistent the disease will be.”

Dr. Imundo said the ILAR classification’s “time is limited,” and rheumatologists may soon need to adopt a new way of classifying children with rheumatic disease – “a more data-driven, genetics-driven scheme.”

“These categories are so imperfect, and the patients are changing. I feel like that says to me, let’s find something that’s more predictive that really helps us a little better than what we have now,” she said.

The study had no specific funding. The authors of the study and the editorial have disclosed no relevant financial relationships. Dr. Hausmann reports receiving salary support from CARRA. Dr. Imundo and Dr. Wahezi have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

“Children are not little adults” is a common refrain in pediatric medicine, but when it comes to a condition like juvenile idiopathic arthritis (JIA), rheumatologists might be better off treating pediatric and adult rheumatic disease more similarly.

A recent study published in Arthritis Care & Research followed children diagnosed with JIA for 18 years. Although not the first long-term study to examine children with JIA, it is unique in that it took place “during a time where biologic DMARDs [disease-modifying antirheumatic drugs] were emerging as a fundamental therapy in the management of children with JIA,” said Dawn M. Wahezi, MD, chief of the division of pediatric rheumatology at the Children’s Hospital at Montefiore in New York, who was not involved with the study.

SrdjanPav/E+/Getty Images

Additionally, the study highlights the International League of Associations for Rheumatology (ILAR) consensus-based classification criteria as an imperfect method to categorize patients with JIA.

Mia Glerup, MD, PhD, of the department of pediatrics at Aarhus (Denmark) University Hospital and colleagues prospectively analyzed 373 patients from Denmark, Norway, Sweden, and Finland with new-onset JIA between 1997 and 2000 and evaluated them at baseline, 8 years, and 18 years. At each visit, the researchers collected data on demographics, disease activity, ILAR category, treatment, and blood samples.

Patients in the cohort were mostly girls (66.7%) with a median age of 5.9 years at onset. Approximately one-third (34.8%) of patients were antinuclear antibody (ANA) positive and 21.6% were HLA-B27 positive. The most common JIA categories at baseline were persistent oligoarthritis (53.9%), polyarticular rheumatoid factor (RF) negative (21.1%), and undifferentiated arthritis (10.2%).

Dr. Glerup and colleagues found that the proportion of patients not receiving DMARDs declined from 73.2% at baseline to 59.7% at 8 years, and then rose again to 70% at 18 years (risk ratio, 1.3; P = .003). The group of 103 patients who used conventional DMARDs (cDMARDs) either as monotherapy or in combination with a biologic DMARD (bDMARD) at 8 years dwindled to 44 (42.7%) at 18 years (RR, 0.4; P < .001), whereas 32 of 52 patients (61.5%) using bDMARDs at 8 years were still taking them at 18 years (RR, 0.6; P = .02). Across the whole study, 14.7% of patients never received any JIA treatment, and 33 of 85 patients (38.8%) on continuous DMARDs developed uveitis during the study period.

Overall, 62.7% of patients received DMARDs at least once, including 89.7% with polyarticular RF negative, 77.3% with oligoarticular extended, 76.9% with systemic, 75.7% with juvenile enthesitis-related arthritis (ERA), 66.7% with polyarticular RF-positive, 65.2% with juvenile psoriatic arthritis (JPsA), 58.9% with undifferentiated JIA, and 27.6% of patients with persistent oligoarticular disease.

The median number of active joints dropped from 3 (range, 1-30) at baseline to 0 at 8 years (range, 0-13), whereas the median cumulative number of affected joints rose from 3 at baseline (range, 1-30) to 6 at 8 years (range, 1-41). At last follow-up, the median number of active joints was 0 (range, 0-5) and median cumulative number of affected joints was 7 (range, 1-47). The percentage of patients in remission barely changed from 52% at 8 years to 51% at 18.

Some patients also changed ILAR categories during the study period, with 7% shifting between baseline and 8 years, and 11% shifting between 8-year and 18-year follow-up. Compared with baseline, by the 18-year follow-up time point there was a significant decrease in the number of patients categorized as oligoarticular (230 vs. 197 patients; P = .02), a significant increase in patients in the psoriatic ILAR category (8 vs. 28 patients; P < .001), and a nonsignificant increase in the number of patients in the undifferentiated category (45 vs. 63 patients; P = .06).

“Almost half of the changes in the distribution between the ILAR categories were caused by updated information on heredity in a first-degree relative obtained at the follow-up visits,” Dr. Glerup and colleagues write.

“That kind of weaves its way through the whole study, because then they show a lot of patients have come off their medication. Patients who had more severe disease in more joints would be less likely, I think, to just stop their medication and stop going to doctors,” Dr. Imundo explained.

Although the study is valuable for its long-term follow-up, there is also a question of generalizability across a more diverse ethnic and racial group. The authors do not elaborate on the racial breakdown of their patients, Dr. Imundo said, “so we’re going to have to assume that the vast majority are going to [have] Caucasian Nordic ethnic background, and that goes along with them having this high percentage of HLA-B27 positivity, which is a gene that’s more prevalent in northern European populations.”

Jonathan Hausmann, MD, a pediatric and adult rheumatologist at Boston Children’s Hospital, Boston,, told this news organization that he believes the overall conclusions from the study – that JIA persists over time and that ILAR classification is a somewhat imprecise measure of assessing JIA types in children – would be generalizable to other groups.

However, long-term registries evaluating JIA in more diverse populations, such as the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry, could confirm these results, said Dr. Hausmann, who is a registry informatics associate with CARRA and was not associated with the research.
 

Long-term management of JIA

In an accompanying editorial, Jaime Guzman, MD, MSc, and Ross E. Petty, MD, PhD, of British Columbia Children’s Hospital and the University of British Columbia, Vancouver, said a rheumatologist’s interpretation of the study would be tied to what they learned about children with arthritis in medical school. They would see the glass as “half full” if children who achieved remission stayed in remission if they learned that a child might end up outgrowing JIA but potentially develop lifelong disability, whereas others may focus on the outcome of approximately half of patients not achieving remission.

“When I was going through medical school, I remember learning that JIA is a disease of children, and typically, they outgrow it as they become adults,” Dr. Hausmann said. “I think this study and many other studies have shown that that’s actually not the case – that, in fact, it may be a majority of kids continue having active disease even through adulthood.”

If a rheumatologist knows JIA is likely to continue into adulthood, “that’s huge,” Dr. Hausmann said. “That means when we first diagnose patients with JIA as kids, we need to set expectations with the families that this may not just go away; this may be something that could be more lifelong.”

Education on the part of the patient, their parents, and their clinician on the expected trajectory of the disease is critical so that children can continue their own care as they transition to adulthood, Dr. Hausmann explained. “The earlier the kids develop the skills to discuss their medicines, their side effects, the better they’ll be able to transition to adult medicine,” he said.

For the patients who go into remission and stay in remission, the message is also important. “To have the reassurance that a lot of those kids won’t be having active joint symptoms or need to be on medication, that’s a huge positive message that can get out there, so I think that’s great,” Dr. Imundo said.
 

Time to move on from ILAR classification?

Another big takeaway from the study was how patients’ ILAR classification changed across the 18-year follow-up. First proposed in 1995, the JIA ILAR classification has been revised several times for clarification purposes. In its current form, the ILAR classification considers a patient’s history when categorizing JIA types but also includes factors such as immediate family history. This system of assessing JIA has been criticized and there are initiatives to create a new JIA classification system to replace it.

“The ILAR criteria were designed to classify patients 6 months after disease onset in an attempt to find some commonality in clinical phenotypes, prognosis, and suggested management,” Dr. Wahezi said. “While there continues to be debate as to whether we can improve our classification of JIA patients, it is not surprising that phenotypes may evolve over time as new clinical features develop. As pediatric rheumatologists, we are well accustomed to having to modify management plans as children manifest with new clinical features over time.”

Although the percentage of patients who switched ILAR classifications over the study period was “much higher” than she would have thought, Dr. Imundo said it was the reasons provided in the study that seemed odd to her. “The classification scheme relies on your family history, like someone else in your family now has psoriasis, so your arthritis classification changes,” she explained.

“We want to head toward a much more unified classification scheme, a simpler one. We now understand that some of the diseases that we see in pediatrics are really the equivalent or same disease in adults,” she said.

“Most of the pediatric categories of JIA have distinct adult correlates,” Dr. Hausmann agreed. RF-positive polyarthritis in children and rheumatoid arthritis in adults are correlated, as are systemic JIA and adult-onset Still’s disease, he explained. “That has been borne out also by genetic susceptibility studies that the genetic predispositions to systemic arthritis in children is the same as the genetic predisposition to adult-onset Still’s disease in adults. By and large, there are a lot of similarities between the two.

“I think we need to incorporate some of that knowledge in better classifying kids with JIA so that we can find the best treatments and the best outcomes, and we can provide information to families about the expected course of the disease over time so that can inform our discussions.”

Some pediatric rheumatologists accept the classification system is flawed, but not all concur with the degree to which these problems impact patient care. “While the ILAR classification criteria may be subject to criticism, it does provide general context and prognostic implications for patients and families,” Dr. Wahezi said.

“The medicines certainly are very similar across the JIA categories, so the implications are not as broad” when classification changes,” Dr. Hausmann said. “But it certainly shows that there are things that we still don’t know. I think classification is actually pretty important because it might give you a sense of how persistent the disease will be.”

Dr. Imundo said the ILAR classification’s “time is limited,” and rheumatologists may soon need to adopt a new way of classifying children with rheumatic disease – “a more data-driven, genetics-driven scheme.”

“These categories are so imperfect, and the patients are changing. I feel like that says to me, let’s find something that’s more predictive that really helps us a little better than what we have now,” she said.

The study had no specific funding. The authors of the study and the editorial have disclosed no relevant financial relationships. Dr. Hausmann reports receiving salary support from CARRA. Dr. Imundo and Dr. Wahezi have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

“Children are not little adults” is a common refrain in pediatric medicine, but when it comes to a condition like juvenile idiopathic arthritis (JIA), rheumatologists might be better off treating pediatric and adult rheumatic disease more similarly.

A recent study published in Arthritis Care & Research followed children diagnosed with JIA for 18 years. Although not the first long-term study to examine children with JIA, it is unique in that it took place “during a time where biologic DMARDs [disease-modifying antirheumatic drugs] were emerging as a fundamental therapy in the management of children with JIA,” said Dawn M. Wahezi, MD, chief of the division of pediatric rheumatology at the Children’s Hospital at Montefiore in New York, who was not involved with the study.

SrdjanPav/E+/Getty Images

Additionally, the study highlights the International League of Associations for Rheumatology (ILAR) consensus-based classification criteria as an imperfect method to categorize patients with JIA.

Mia Glerup, MD, PhD, of the department of pediatrics at Aarhus (Denmark) University Hospital and colleagues prospectively analyzed 373 patients from Denmark, Norway, Sweden, and Finland with new-onset JIA between 1997 and 2000 and evaluated them at baseline, 8 years, and 18 years. At each visit, the researchers collected data on demographics, disease activity, ILAR category, treatment, and blood samples.

Patients in the cohort were mostly girls (66.7%) with a median age of 5.9 years at onset. Approximately one-third (34.8%) of patients were antinuclear antibody (ANA) positive and 21.6% were HLA-B27 positive. The most common JIA categories at baseline were persistent oligoarthritis (53.9%), polyarticular rheumatoid factor (RF) negative (21.1%), and undifferentiated arthritis (10.2%).

Dr. Glerup and colleagues found that the proportion of patients not receiving DMARDs declined from 73.2% at baseline to 59.7% at 8 years, and then rose again to 70% at 18 years (risk ratio, 1.3; P = .003). The group of 103 patients who used conventional DMARDs (cDMARDs) either as monotherapy or in combination with a biologic DMARD (bDMARD) at 8 years dwindled to 44 (42.7%) at 18 years (RR, 0.4; P < .001), whereas 32 of 52 patients (61.5%) using bDMARDs at 8 years were still taking them at 18 years (RR, 0.6; P = .02). Across the whole study, 14.7% of patients never received any JIA treatment, and 33 of 85 patients (38.8%) on continuous DMARDs developed uveitis during the study period.

Overall, 62.7% of patients received DMARDs at least once, including 89.7% with polyarticular RF negative, 77.3% with oligoarticular extended, 76.9% with systemic, 75.7% with juvenile enthesitis-related arthritis (ERA), 66.7% with polyarticular RF-positive, 65.2% with juvenile psoriatic arthritis (JPsA), 58.9% with undifferentiated JIA, and 27.6% of patients with persistent oligoarticular disease.

The median number of active joints dropped from 3 (range, 1-30) at baseline to 0 at 8 years (range, 0-13), whereas the median cumulative number of affected joints rose from 3 at baseline (range, 1-30) to 6 at 8 years (range, 1-41). At last follow-up, the median number of active joints was 0 (range, 0-5) and median cumulative number of affected joints was 7 (range, 1-47). The percentage of patients in remission barely changed from 52% at 8 years to 51% at 18.

Some patients also changed ILAR categories during the study period, with 7% shifting between baseline and 8 years, and 11% shifting between 8-year and 18-year follow-up. Compared with baseline, by the 18-year follow-up time point there was a significant decrease in the number of patients categorized as oligoarticular (230 vs. 197 patients; P = .02), a significant increase in patients in the psoriatic ILAR category (8 vs. 28 patients; P < .001), and a nonsignificant increase in the number of patients in the undifferentiated category (45 vs. 63 patients; P = .06).

“Almost half of the changes in the distribution between the ILAR categories were caused by updated information on heredity in a first-degree relative obtained at the follow-up visits,” Dr. Glerup and colleagues write.

“That kind of weaves its way through the whole study, because then they show a lot of patients have come off their medication. Patients who had more severe disease in more joints would be less likely, I think, to just stop their medication and stop going to doctors,” Dr. Imundo explained.

Although the study is valuable for its long-term follow-up, there is also a question of generalizability across a more diverse ethnic and racial group. The authors do not elaborate on the racial breakdown of their patients, Dr. Imundo said, “so we’re going to have to assume that the vast majority are going to [have] Caucasian Nordic ethnic background, and that goes along with them having this high percentage of HLA-B27 positivity, which is a gene that’s more prevalent in northern European populations.”

Jonathan Hausmann, MD, a pediatric and adult rheumatologist at Boston Children’s Hospital, Boston,, told this news organization that he believes the overall conclusions from the study – that JIA persists over time and that ILAR classification is a somewhat imprecise measure of assessing JIA types in children – would be generalizable to other groups.

However, long-term registries evaluating JIA in more diverse populations, such as the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry, could confirm these results, said Dr. Hausmann, who is a registry informatics associate with CARRA and was not associated with the research.
 

Long-term management of JIA

In an accompanying editorial, Jaime Guzman, MD, MSc, and Ross E. Petty, MD, PhD, of British Columbia Children’s Hospital and the University of British Columbia, Vancouver, said a rheumatologist’s interpretation of the study would be tied to what they learned about children with arthritis in medical school. They would see the glass as “half full” if children who achieved remission stayed in remission if they learned that a child might end up outgrowing JIA but potentially develop lifelong disability, whereas others may focus on the outcome of approximately half of patients not achieving remission.

“When I was going through medical school, I remember learning that JIA is a disease of children, and typically, they outgrow it as they become adults,” Dr. Hausmann said. “I think this study and many other studies have shown that that’s actually not the case – that, in fact, it may be a majority of kids continue having active disease even through adulthood.”

If a rheumatologist knows JIA is likely to continue into adulthood, “that’s huge,” Dr. Hausmann said. “That means when we first diagnose patients with JIA as kids, we need to set expectations with the families that this may not just go away; this may be something that could be more lifelong.”

Education on the part of the patient, their parents, and their clinician on the expected trajectory of the disease is critical so that children can continue their own care as they transition to adulthood, Dr. Hausmann explained. “The earlier the kids develop the skills to discuss their medicines, their side effects, the better they’ll be able to transition to adult medicine,” he said.

For the patients who go into remission and stay in remission, the message is also important. “To have the reassurance that a lot of those kids won’t be having active joint symptoms or need to be on medication, that’s a huge positive message that can get out there, so I think that’s great,” Dr. Imundo said.
 

Time to move on from ILAR classification?

Another big takeaway from the study was how patients’ ILAR classification changed across the 18-year follow-up. First proposed in 1995, the JIA ILAR classification has been revised several times for clarification purposes. In its current form, the ILAR classification considers a patient’s history when categorizing JIA types but also includes factors such as immediate family history. This system of assessing JIA has been criticized and there are initiatives to create a new JIA classification system to replace it.

“The ILAR criteria were designed to classify patients 6 months after disease onset in an attempt to find some commonality in clinical phenotypes, prognosis, and suggested management,” Dr. Wahezi said. “While there continues to be debate as to whether we can improve our classification of JIA patients, it is not surprising that phenotypes may evolve over time as new clinical features develop. As pediatric rheumatologists, we are well accustomed to having to modify management plans as children manifest with new clinical features over time.”

Although the percentage of patients who switched ILAR classifications over the study period was “much higher” than she would have thought, Dr. Imundo said it was the reasons provided in the study that seemed odd to her. “The classification scheme relies on your family history, like someone else in your family now has psoriasis, so your arthritis classification changes,” she explained.

“We want to head toward a much more unified classification scheme, a simpler one. We now understand that some of the diseases that we see in pediatrics are really the equivalent or same disease in adults,” she said.

“Most of the pediatric categories of JIA have distinct adult correlates,” Dr. Hausmann agreed. RF-positive polyarthritis in children and rheumatoid arthritis in adults are correlated, as are systemic JIA and adult-onset Still’s disease, he explained. “That has been borne out also by genetic susceptibility studies that the genetic predispositions to systemic arthritis in children is the same as the genetic predisposition to adult-onset Still’s disease in adults. By and large, there are a lot of similarities between the two.

“I think we need to incorporate some of that knowledge in better classifying kids with JIA so that we can find the best treatments and the best outcomes, and we can provide information to families about the expected course of the disease over time so that can inform our discussions.”

Some pediatric rheumatologists accept the classification system is flawed, but not all concur with the degree to which these problems impact patient care. “While the ILAR classification criteria may be subject to criticism, it does provide general context and prognostic implications for patients and families,” Dr. Wahezi said.

“The medicines certainly are very similar across the JIA categories, so the implications are not as broad” when classification changes,” Dr. Hausmann said. “But it certainly shows that there are things that we still don’t know. I think classification is actually pretty important because it might give you a sense of how persistent the disease will be.”

Dr. Imundo said the ILAR classification’s “time is limited,” and rheumatologists may soon need to adopt a new way of classifying children with rheumatic disease – “a more data-driven, genetics-driven scheme.”

“These categories are so imperfect, and the patients are changing. I feel like that says to me, let’s find something that’s more predictive that really helps us a little better than what we have now,” she said.

The study had no specific funding. The authors of the study and the editorial have disclosed no relevant financial relationships. Dr. Hausmann reports receiving salary support from CARRA. Dr. Imundo and Dr. Wahezi have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: External beam radiotherapy (EBRT) plus brachytherapy (BT) boost improves survival in patients with unfavorable intermediate-risk prostate cancer vs. brachytherapy alone.

Major finding: The median follow-up was 68 months. In weight-adjusted analysis, EBRT plus BT (hazard ratio [HR] 0.82; P = .000005) vs. BT alone significantly improves overall survival (OS). At 10 years, the OS rate was 62.4% and 69.3% in the BT alone and EBRT plus BT groups, respectively (P < .0001).

Study details: This was a retrospective study of 11,721 patients with unfavorable intermediate-risk prostate cancer diagnosed between 2004 and 2015. The patients received either definitive BT without androgen deprivation therapy (ADT), BT with ADT, EBRT with ADT, or EBRT with BT and ADT.

Disclosures: This work was supported by Washington University in St. Louis Medical School and Barnes Jewish Hospital. The authors received advisory/consulting/scientific fees and honoraria outside this work.

Source: Andruska N et al. Brachytherapy. 2022 (Feb 2). Doi: 10.1016/j.brachy.2021.12.008.

Key clinical point: External beam radiotherapy (EBRT) plus brachytherapy (BT) boost improves survival in patients with unfavorable intermediate-risk prostate cancer vs. brachytherapy alone.

Major finding: The median follow-up was 68 months. In weight-adjusted analysis, EBRT plus BT (hazard ratio [HR] 0.82; P = .000005) vs. BT alone significantly improves overall survival (OS). At 10 years, the OS rate was 62.4% and 69.3% in the BT alone and EBRT plus BT groups, respectively (P < .0001).

Study details: This was a retrospective study of 11,721 patients with unfavorable intermediate-risk prostate cancer diagnosed between 2004 and 2015. The patients received either definitive BT without androgen deprivation therapy (ADT), BT with ADT, EBRT with ADT, or EBRT with BT and ADT.

Disclosures: This work was supported by Washington University in St. Louis Medical School and Barnes Jewish Hospital. The authors received advisory/consulting/scientific fees and honoraria outside this work.

Source: Andruska N et al. Brachytherapy. 2022 (Feb 2). Doi: 10.1016/j.brachy.2021.12.008.

Key clinical point: External beam radiotherapy (EBRT) plus brachytherapy (BT) boost improves survival in patients with unfavorable intermediate-risk prostate cancer vs. brachytherapy alone.

Major finding: The median follow-up was 68 months. In weight-adjusted analysis, EBRT plus BT (hazard ratio [HR] 0.82; P = .000005) vs. BT alone significantly improves overall survival (OS). At 10 years, the OS rate was 62.4% and 69.3% in the BT alone and EBRT plus BT groups, respectively (P < .0001).

Study details: This was a retrospective study of 11,721 patients with unfavorable intermediate-risk prostate cancer diagnosed between 2004 and 2015. The patients received either definitive BT without androgen deprivation therapy (ADT), BT with ADT, EBRT with ADT, or EBRT with BT and ADT.

Disclosures: This work was supported by Washington University in St. Louis Medical School and Barnes Jewish Hospital. The authors received advisory/consulting/scientific fees and honoraria outside this work.

Source: Andruska N et al. Brachytherapy. 2022 (Feb 2). Doi: 10.1016/j.brachy.2021.12.008.

Key clinical point: Focal high-intensity focused ultrasound (HIFU) shows good cancer control in patients with nonmetastatic prostate cancer.

Major finding: At 7 years, failure-free survival was 69% (95% CI 64%-74%). In patients with intermediate- and high-risk cancers, failure-free survival at 7 years was 68% (95% CI 62%-75%) and 65% (95% CI 56%-74%), respectively.

Study details: This was a study of 1,379 patients with nonmetastatic prostate cancer including intermediate- (65%) and high-risk (28%) categories from a prospective registry who received focal therapy using HIFU during 2005-2020.

Disclosures: This work was supported by Sonacare Inc. The authors received research funding, consulting/advisory fees, and travel grants. Some of the authors were paid proctors to give training on the procedures.

Source: Reddy D et al. Eur Urol. 2022 (Feb 3). Doi: 10.1016/j.eururo.2022.01.005.

Key clinical point: Focal high-intensity focused ultrasound (HIFU) shows good cancer control in patients with nonmetastatic prostate cancer.

Major finding: At 7 years, failure-free survival was 69% (95% CI 64%-74%). In patients with intermediate- and high-risk cancers, failure-free survival at 7 years was 68% (95% CI 62%-75%) and 65% (95% CI 56%-74%), respectively.

Study details: This was a study of 1,379 patients with nonmetastatic prostate cancer including intermediate- (65%) and high-risk (28%) categories from a prospective registry who received focal therapy using HIFU during 2005-2020.

Disclosures: This work was supported by Sonacare Inc. The authors received research funding, consulting/advisory fees, and travel grants. Some of the authors were paid proctors to give training on the procedures.

Source: Reddy D et al. Eur Urol. 2022 (Feb 3). Doi: 10.1016/j.eururo.2022.01.005.

Key clinical point: Focal high-intensity focused ultrasound (HIFU) shows good cancer control in patients with nonmetastatic prostate cancer.

Major finding: At 7 years, failure-free survival was 69% (95% CI 64%-74%). In patients with intermediate- and high-risk cancers, failure-free survival at 7 years was 68% (95% CI 62%-75%) and 65% (95% CI 56%-74%), respectively.

Study details: This was a study of 1,379 patients with nonmetastatic prostate cancer including intermediate- (65%) and high-risk (28%) categories from a prospective registry who received focal therapy using HIFU during 2005-2020.

Disclosures: This work was supported by Sonacare Inc. The authors received research funding, consulting/advisory fees, and travel grants. Some of the authors were paid proctors to give training on the procedures.

Source: Reddy D et al. Eur Urol. 2022 (Feb 3). Doi: 10.1016/j.eururo.2022.01.005.

Key clinical point: Use of nonselective beta-blockers at the time of radical prostatectomy is associated with a lower odds of treatment initiation for recurrence in patients with prostate cancer.

Major finding: The use of nonselective beta-blockers at the time of surgery was associated with a significantly lower odds of treatment for cancer recurrence (adjusted hazard ratio 0.64; P = .03). The most common nonselective beta-blockers used were carvedilol (56.9%) and propranolol (25.4%).

Study details: This was a retrospective cohort study of 11,117 patients with prostate cancer who underwent radical prostatectomy between 2008 and 2015.

Disclosures: This study was supported by the Norwegian Cancer Society. The authors received grants from the Norwegian Cancer Society during this work.

Source: Sivanesan S et al. JAMA Netw Open. 2022 (Jan 26). Doi: 10.1001/jamanetworkopen.2021.45230.

Key clinical point: Use of nonselective beta-blockers at the time of radical prostatectomy is associated with a lower odds of treatment initiation for recurrence in patients with prostate cancer.

Major finding: The use of nonselective beta-blockers at the time of surgery was associated with a significantly lower odds of treatment for cancer recurrence (adjusted hazard ratio 0.64; P = .03). The most common nonselective beta-blockers used were carvedilol (56.9%) and propranolol (25.4%).

Study details: This was a retrospective cohort study of 11,117 patients with prostate cancer who underwent radical prostatectomy between 2008 and 2015.

Disclosures: This study was supported by the Norwegian Cancer Society. The authors received grants from the Norwegian Cancer Society during this work.

Source: Sivanesan S et al. JAMA Netw Open. 2022 (Jan 26). Doi: 10.1001/jamanetworkopen.2021.45230.

Key clinical point: Use of nonselective beta-blockers at the time of radical prostatectomy is associated with a lower odds of treatment initiation for recurrence in patients with prostate cancer.

Major finding: The use of nonselective beta-blockers at the time of surgery was associated with a significantly lower odds of treatment for cancer recurrence (adjusted hazard ratio 0.64; P = .03). The most common nonselective beta-blockers used were carvedilol (56.9%) and propranolol (25.4%).

Study details: This was a retrospective cohort study of 11,117 patients with prostate cancer who underwent radical prostatectomy between 2008 and 2015.

Disclosures: This study was supported by the Norwegian Cancer Society. The authors received grants from the Norwegian Cancer Society during this work.

Source: Sivanesan S et al. JAMA Netw Open. 2022 (Jan 26). Doi: 10.1001/jamanetworkopen.2021.45230.

Key clinical point: Angiotensin-converting enzyme inhibitors (ACEi) use during radiotherapy is associated with a lower risk for hematuria in patients with prostate cancer. The effect was independent of clinical factors associated with late hematuria.

Major finding: The cumulative probability of hematuria at 4 years in patients receiving ACEi during radiotherapy was significantly lower vs. nonusers (4.8% vs. 16.5%). The risk for hematuria was significantly lower in patients receiving ACEi (adjusted hazard ratio 0.51; P = .030) after adjusting for clinical factors associated with hematuria.

Study details: This article reported on two multicenter observational studies, URWCI (n = 256) and REQUITE (n = 1,437), of patients with prostate cancer undergoing radiotherapy.

Disclosures: This work was supported by the National Cancer Institute, University of Rochester Wilmot Cancer Institute, Cancer Research UK, and others. The authors reported no competing interests.

Source: Kerns SL et al. Radiother Oncol. 2022;168:P75-82 (Jan 22). Doi: 10.1016/j.radonc.2022.01.014.

Key clinical point: Angiotensin-converting enzyme inhibitors (ACEi) use during radiotherapy is associated with a lower risk for hematuria in patients with prostate cancer. The effect was independent of clinical factors associated with late hematuria.

Major finding: The cumulative probability of hematuria at 4 years in patients receiving ACEi during radiotherapy was significantly lower vs. nonusers (4.8% vs. 16.5%). The risk for hematuria was significantly lower in patients receiving ACEi (adjusted hazard ratio 0.51; P = .030) after adjusting for clinical factors associated with hematuria.

Study details: This article reported on two multicenter observational studies, URWCI (n = 256) and REQUITE (n = 1,437), of patients with prostate cancer undergoing radiotherapy.

Disclosures: This work was supported by the National Cancer Institute, University of Rochester Wilmot Cancer Institute, Cancer Research UK, and others. The authors reported no competing interests.

Source: Kerns SL et al. Radiother Oncol. 2022;168:P75-82 (Jan 22). Doi: 10.1016/j.radonc.2022.01.014.

Key clinical point: Angiotensin-converting enzyme inhibitors (ACEi) use during radiotherapy is associated with a lower risk for hematuria in patients with prostate cancer. The effect was independent of clinical factors associated with late hematuria.

Major finding: The cumulative probability of hematuria at 4 years in patients receiving ACEi during radiotherapy was significantly lower vs. nonusers (4.8% vs. 16.5%). The risk for hematuria was significantly lower in patients receiving ACEi (adjusted hazard ratio 0.51; P = .030) after adjusting for clinical factors associated with hematuria.

Study details: This article reported on two multicenter observational studies, URWCI (n = 256) and REQUITE (n = 1,437), of patients with prostate cancer undergoing radiotherapy.

Disclosures: This work was supported by the National Cancer Institute, University of Rochester Wilmot Cancer Institute, Cancer Research UK, and others. The authors reported no competing interests.

Source: Kerns SL et al. Radiother Oncol. 2022;168:P75-82 (Jan 22). Doi: 10.1016/j.radonc.2022.01.014.

Key clinical point: Obesity (body mass index of ≥30 kg/m²) is associated with high-risk prostate cancer in non-Hispanic Black (NHB) and Hispanic men.

Major finding: Obesity showed an independent association with high-risk prostate cancer (odds ratio [OR] 2.23; 95% CI 1.28-3.81). Compared with nonobese men without diabetes mellitus (DM), those with obesity and DM showed a higher risk for intermediate- (OR 1.93; P = .013) and high-risk prostate cancer (OR 2.40; P = .011).

Study details: This was a retrospective study of 1,303 patients with prostate cancer. The prevalence of obesity and DM was 29.3% and 28.3%, respectively. Most of the patients were of NHB (38%) or Hispanic ethnicity (31%).

Disclosures: This work was funded by the American Cancer Society. The authors declared no conflicts of interest.

Source: Zhu D et al. Clin Genitourin Cancer. 2022 (Jan 31). Doi: 10.1016/j.clgc.2022.01.016.

Key clinical point: Obesity (body mass index of ≥30 kg/m²) is associated with high-risk prostate cancer in non-Hispanic Black (NHB) and Hispanic men.

Major finding: Obesity showed an independent association with high-risk prostate cancer (odds ratio [OR] 2.23; 95% CI 1.28-3.81). Compared with nonobese men without diabetes mellitus (DM), those with obesity and DM showed a higher risk for intermediate- (OR 1.93; P = .013) and high-risk prostate cancer (OR 2.40; P = .011).

Study details: This was a retrospective study of 1,303 patients with prostate cancer. The prevalence of obesity and DM was 29.3% and 28.3%, respectively. Most of the patients were of NHB (38%) or Hispanic ethnicity (31%).

Disclosures: This work was funded by the American Cancer Society. The authors declared no conflicts of interest.

Source: Zhu D et al. Clin Genitourin Cancer. 2022 (Jan 31). Doi: 10.1016/j.clgc.2022.01.016.

Key clinical point: Obesity (body mass index of ≥30 kg/m²) is associated with high-risk prostate cancer in non-Hispanic Black (NHB) and Hispanic men.

Major finding: Obesity showed an independent association with high-risk prostate cancer (odds ratio [OR] 2.23; 95% CI 1.28-3.81). Compared with nonobese men without diabetes mellitus (DM), those with obesity and DM showed a higher risk for intermediate- (OR 1.93; P = .013) and high-risk prostate cancer (OR 2.40; P = .011).

Study details: This was a retrospective study of 1,303 patients with prostate cancer. The prevalence of obesity and DM was 29.3% and 28.3%, respectively. Most of the patients were of NHB (38%) or Hispanic ethnicity (31%).

Disclosures: This work was funded by the American Cancer Society. The authors declared no conflicts of interest.

Source: Zhu D et al. Clin Genitourin Cancer. 2022 (Jan 31). Doi: 10.1016/j.clgc.2022.01.016.

Key clinical point: The risk for metastasis and cancer-specific mortality is significantly higher in patients with favorable and unfavorable intermediate-risk vs. low-risk patients with prostate cancer managed with active surveillance.

Major finding: The risk for metastasis and prostate cancer-specific mortality was significantly higher in patients with favorable (subdistribution hazard ratios [SHR] 6.49 and 2.94, respectively; both P < .001) and unfavorable (SHR 14.45 and 7.90, respectively; P < .001) intermediate-risk disease vs. those with low-risk disease.

Study details: This was a retrospective study of 9,733 patients with low- or intermediate-risk prostate cancer undergoing active surveillance between 2001 and 2015.

Disclosures: This study was sponsored by the National Institutes of Health and U.S. Department of Defense. Several of the authors received consulting/speaker fees, honoraria, travel support, and other financial and nonfinancial interests, served on advisory boards, or were employed by pharmaceutical companies. The other authors had no conflicts of interest.

Source: Courtney PT et al. J Natl Compr Canc Netw. 2022;20(2):151-159 (Feb 1). Doi:  10.6004/jnccn.2021.7065.

Key clinical point: The risk for metastasis and cancer-specific mortality is significantly higher in patients with favorable and unfavorable intermediate-risk vs. low-risk patients with prostate cancer managed with active surveillance.

Major finding: The risk for metastasis and prostate cancer-specific mortality was significantly higher in patients with favorable (subdistribution hazard ratios [SHR] 6.49 and 2.94, respectively; both P < .001) and unfavorable (SHR 14.45 and 7.90, respectively; P < .001) intermediate-risk disease vs. those with low-risk disease.

Study details: This was a retrospective study of 9,733 patients with low- or intermediate-risk prostate cancer undergoing active surveillance between 2001 and 2015.

Disclosures: This study was sponsored by the National Institutes of Health and U.S. Department of Defense. Several of the authors received consulting/speaker fees, honoraria, travel support, and other financial and nonfinancial interests, served on advisory boards, or were employed by pharmaceutical companies. The other authors had no conflicts of interest.

Source: Courtney PT et al. J Natl Compr Canc Netw. 2022;20(2):151-159 (Feb 1). Doi:  10.6004/jnccn.2021.7065.

Key clinical point: The risk for metastasis and cancer-specific mortality is significantly higher in patients with favorable and unfavorable intermediate-risk vs. low-risk patients with prostate cancer managed with active surveillance.

Major finding: The risk for metastasis and prostate cancer-specific mortality was significantly higher in patients with favorable (subdistribution hazard ratios [SHR] 6.49 and 2.94, respectively; both P < .001) and unfavorable (SHR 14.45 and 7.90, respectively; P < .001) intermediate-risk disease vs. those with low-risk disease.

Study details: This was a retrospective study of 9,733 patients with low- or intermediate-risk prostate cancer undergoing active surveillance between 2001 and 2015.

Disclosures: This study was sponsored by the National Institutes of Health and U.S. Department of Defense. Several of the authors received consulting/speaker fees, honoraria, travel support, and other financial and nonfinancial interests, served on advisory boards, or were employed by pharmaceutical companies. The other authors had no conflicts of interest.

Source: Courtney PT et al. J Natl Compr Canc Netw. 2022;20(2):151-159 (Feb 1). Doi:  10.6004/jnccn.2021.7065.

Key clinical point: In patients with prostate cancer, salvage radiotherapy (SRT) for biochemical recurrence after radical prostatectomy is associated with improved survival in the long term.

Major finding: The median follow up was 95.9 months. At 15 years, SRT was associated with a significantly higher metastasis-free survival (84.3% vs. 76.9%; adjusted hazard ratio [aHR] 0.37; P < .001) and overall survival (85.3% vs. 74.4%; aHR 0.64; P = .03).

Study details: A propensity score-matched analysis of 874 patients with prostate cancer who experienced biochemical recurrence after radical prostatectomy and underwent SRT or observation between 1989 and 2016.

Disclosures: No external funding source was identified for this work. The authors declared no conflicts of interest.

Source: Tilki D et al. Cancers. 2022;14(3):740 (Jan 31). Doi: 10.3390/cancers14030740.

Key clinical point: In patients with prostate cancer, salvage radiotherapy (SRT) for biochemical recurrence after radical prostatectomy is associated with improved survival in the long term.

Major finding: The median follow up was 95.9 months. At 15 years, SRT was associated with a significantly higher metastasis-free survival (84.3% vs. 76.9%; adjusted hazard ratio [aHR] 0.37; P < .001) and overall survival (85.3% vs. 74.4%; aHR 0.64; P = .03).

Study details: A propensity score-matched analysis of 874 patients with prostate cancer who experienced biochemical recurrence after radical prostatectomy and underwent SRT or observation between 1989 and 2016.

Disclosures: No external funding source was identified for this work. The authors declared no conflicts of interest.

Source: Tilki D et al. Cancers. 2022;14(3):740 (Jan 31). Doi: 10.3390/cancers14030740.

Key clinical point: In patients with prostate cancer, salvage radiotherapy (SRT) for biochemical recurrence after radical prostatectomy is associated with improved survival in the long term.

Major finding: The median follow up was 95.9 months. At 15 years, SRT was associated with a significantly higher metastasis-free survival (84.3% vs. 76.9%; adjusted hazard ratio [aHR] 0.37; P < .001) and overall survival (85.3% vs. 74.4%; aHR 0.64; P = .03).

Study details: A propensity score-matched analysis of 874 patients with prostate cancer who experienced biochemical recurrence after radical prostatectomy and underwent SRT or observation between 1989 and 2016.

Disclosures: No external funding source was identified for this work. The authors declared no conflicts of interest.

Source: Tilki D et al. Cancers. 2022;14(3):740 (Jan 31). Doi: 10.3390/cancers14030740.

Key clinical point: Adding androgen deprivation therapy (ADT) to radiotherapy in men with intermediate-/high-risk localized prostate cancer improves metastasis-free survival (MFS).

Major finding: At a median follow-up of 11.4 years, the addition of ADT to radiotherapy significantly improved MFS (hazard ratio [HR] 0.83; P < .0001). Prolonged adjuvant ADT also improved MFS (HR 0.84; P < .0001).

Study details: This was an individual patient data meta-analysis of 10,853 patients with localized prostate cancer from 12 randomized trials.

Disclosures: This work was funded by the University Hospitals Seidman Cancer Center, Prostate Cancer Foundation, and the American Society for Radiation Oncology. The authors received personal/consulting/advisory fees and research support or reported being a member of the clinical trial steering committee and holding stocks outside this work.

Source: Kishan AU et al. Lancet Oncol. 2022;23(2):P304-16 (Jan 17). Doi: 10.1016/ S1470-2045(21)00705-1.

Key clinical point: Adding androgen deprivation therapy (ADT) to radiotherapy in men with intermediate-/high-risk localized prostate cancer improves metastasis-free survival (MFS).

Major finding: At a median follow-up of 11.4 years, the addition of ADT to radiotherapy significantly improved MFS (hazard ratio [HR] 0.83; P < .0001). Prolonged adjuvant ADT also improved MFS (HR 0.84; P < .0001).

Study details: This was an individual patient data meta-analysis of 10,853 patients with localized prostate cancer from 12 randomized trials.

Disclosures: This work was funded by the University Hospitals Seidman Cancer Center, Prostate Cancer Foundation, and the American Society for Radiation Oncology. The authors received personal/consulting/advisory fees and research support or reported being a member of the clinical trial steering committee and holding stocks outside this work.

Source: Kishan AU et al. Lancet Oncol. 2022;23(2):P304-16 (Jan 17). Doi: 10.1016/ S1470-2045(21)00705-1.

Key clinical point: Adding androgen deprivation therapy (ADT) to radiotherapy in men with intermediate-/high-risk localized prostate cancer improves metastasis-free survival (MFS).

Major finding: At a median follow-up of 11.4 years, the addition of ADT to radiotherapy significantly improved MFS (hazard ratio [HR] 0.83; P < .0001). Prolonged adjuvant ADT also improved MFS (HR 0.84; P < .0001).

Study details: This was an individual patient data meta-analysis of 10,853 patients with localized prostate cancer from 12 randomized trials.

Disclosures: This work was funded by the University Hospitals Seidman Cancer Center, Prostate Cancer Foundation, and the American Society for Radiation Oncology. The authors received personal/consulting/advisory fees and research support or reported being a member of the clinical trial steering committee and holding stocks outside this work.

Source: Kishan AU et al. Lancet Oncol. 2022;23(2):P304-16 (Jan 17). Doi: 10.1016/ S1470-2045(21)00705-1.

Key clinical point: Niraparib is tolerable and shows activity in heavily pretreated patients with metastatic castration-resistant prostate cancer (mCRPC) and DNA repair gene defects (DRD).

Major finding: The median follow-up duration was 10 months and 8.6 months in the measurable BRCA and non-BRCA cohorts, respectively. The objective response rate was 34.2% in the measurable BRCA cohort and 10.6% in the measurable non-BRCA cohort. The most common grade 3 or higher adverse events were hematological (anemia, thrombocytopenia, and neutropenia). These adverse events were manageable with treatment interruptions, dose reductions, or supportive measures.

Study details: An open-label, single-arm, phase 2 GALAHAD study of 289 patients with histologically confirmed mCRPC and DRD who were treated with niraparib.

Disclosures: This study was sponsored by Janssen Research & Development. The authors received grants, contracts, payments, honoraria, travel support, and consulting/advisory/personal fees or reported being in a leadership role, holding stocks, or other ownership roles relative to Janssen Research & Development.

Source: Smith MR et al. Lancet Oncol. 2022 (Feb 4). Doi: 10.1016/S1470-2045(21)00757-9.

Key clinical point: Niraparib is tolerable and shows activity in heavily pretreated patients with metastatic castration-resistant prostate cancer (mCRPC) and DNA repair gene defects (DRD).

Major finding: The median follow-up duration was 10 months and 8.6 months in the measurable BRCA and non-BRCA cohorts, respectively. The objective response rate was 34.2% in the measurable BRCA cohort and 10.6% in the measurable non-BRCA cohort. The most common grade 3 or higher adverse events were hematological (anemia, thrombocytopenia, and neutropenia). These adverse events were manageable with treatment interruptions, dose reductions, or supportive measures.

Study details: An open-label, single-arm, phase 2 GALAHAD study of 289 patients with histologically confirmed mCRPC and DRD who were treated with niraparib.

Disclosures: This study was sponsored by Janssen Research & Development. The authors received grants, contracts, payments, honoraria, travel support, and consulting/advisory/personal fees or reported being in a leadership role, holding stocks, or other ownership roles relative to Janssen Research & Development.

Source: Smith MR et al. Lancet Oncol. 2022 (Feb 4). Doi: 10.1016/S1470-2045(21)00757-9.

Key clinical point: Niraparib is tolerable and shows activity in heavily pretreated patients with metastatic castration-resistant prostate cancer (mCRPC) and DNA repair gene defects (DRD).

Major finding: The median follow-up duration was 10 months and 8.6 months in the measurable BRCA and non-BRCA cohorts, respectively. The objective response rate was 34.2% in the measurable BRCA cohort and 10.6% in the measurable non-BRCA cohort. The most common grade 3 or higher adverse events were hematological (anemia, thrombocytopenia, and neutropenia). These adverse events were manageable with treatment interruptions, dose reductions, or supportive measures.

Study details: An open-label, single-arm, phase 2 GALAHAD study of 289 patients with histologically confirmed mCRPC and DRD who were treated with niraparib.

Disclosures: This study was sponsored by Janssen Research & Development. The authors received grants, contracts, payments, honoraria, travel support, and consulting/advisory/personal fees or reported being in a leadership role, holding stocks, or other ownership roles relative to Janssen Research & Development.

Source: Smith MR et al. Lancet Oncol. 2022 (Feb 4). Doi: 10.1016/S1470-2045(21)00757-9.