In children with oligoarticular and polyarticular juvenile idiopathic arthritis, discontinuing treatment prior to 2 years after remission was associated with a greater chance of relapse, according to recently published findings.
multicenter, retrospective study, researchers evaluated clinical chart data of 349 patients followed for JIA at three rheumatology clinics in Italy between January 2000 and March 2016. Eligible patients were on biologics initiated before 18 years of age and had been in clinical remission after a first cycle of biologic treatment for at least 6 months. Patients were also required to have stopped all treatments, including disease-modifying antirheumatic drugs, for at least 3 months. After applying these criteria, the researchers identified 135 eligible patients (38.6% were female patients; overall median age was 14.6 years).
Of the cases evaluated, 87 patients had etanercept; 27 received adalimumab; 12 had infliximab; seven had anakinra and one each had rituximab and abatacept. Drugs were administered for a median period of 20 months. Methotrexate was concomitantly administered to 92% of patients.
The researchers found that after a median follow-up time of 6 months in remission and off therapy, most of the enrolled participants experienced a flare (102/135; 75%). Among patients who relapsed, the same biologic was re-initiated in 34.1%; 19.3% switched to a different biologic; 4.4% restarted methotrexate; 11.9% received intra-articular corticosteroid injection; 2.2% received no treatment; and 0.7% were treated with another antirheumatic medication.
In assessing the time point of 1 year post-treatment discontinuation, 31.1% of patients continued to be in remission. For those who remained in remission, remission lasted for a median of 53 months. This was achieved in 17 of 48 patients with polyarticular onset JIA, in seven of 27 patients with oligoarticular extended onset, in six of 35 patients with oligoarticular persistent onset, in two of six patients with enthesitis-related arthritis, in two of seven patients with psoriatic arthritis and in eight of 12 patients with systemic onset JIA.
Compared with other patients with JIA, those with systemic onset had a higher likelihood of maintaining remission after stopping treatment. An analysis restricted to children with JIA with polyarticular and oligoarticular disease found that patients who continued on biologics greater than 2 years after achieving remission had a greater likelihood of maintaining remission off therapy. None of the other variables evaluated was significantly linked to a long-term remission.
“Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal,” the researchers wrote. – by Jennifer Byrne
: The researchers report no relevant disclosures.