At the study’s four-month mark, those patients who took only methotrexate, were given the other two drugs if they didn’t reach 70 percent improvement. This four-month delay in getting the most aggressive treatment with the combination cocktail reduced the chance of making the disease undetectable, researchers found. In fact, the chances for remission increased by 30 percent for each month sooner that treatment was started.

The study’s lead researcher, Carol Wallace, MD, professor of pediatrics at Children’s Hospital and Regional Medical Center in Seattle, Wash., says the study shows that treating earlier is better than treating later and that “there is truly an advantage to treating aggressively rather than starting slow and ramping up.” Also the study gives physicians a clear definition of “aggressive,” Dr. Wallace says.  

“I hope they will see what they previously thought was aggressive isn’t really aggressive,” Dr. Wallace says. “For every month earlier a child is treated, they have a greater chance of achieving inactive disease by six months.”

Although there are other biologics, also called anti-TNF drugs, approved for treating arthritis, etanercept was chosen for this study because it was the first in its class approved for use in children and therefore has the most safety and effectiveness data, Dr. Giannini says. Dr. Giannini says the drugs have manageable side effects and the potential risk pales in comparison to the severe, irreversible, disabling damage caused by untreated juvenile arthritis.

“We were shooting for inactive disease,” Dr. Giannini says. “Ours was a very high goal. We couldn’t have dreamed of that after only six months of therapy before biologics. Our conclusion is that early, aggressive therapy with a biologic, methotrexate and a little bit of prednisone enhances and increases the probability that we can turn off the disease quickly.”