Clinical Correlates of JIA Relapse After Biologic Therapy Discontinuation

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Children with oligoarticular and polyarticular forms of juvenile idiopathic arthritis who discontinue biologic therapy before 2 years from remission have a high likelihood of disease relapse.
Children with oligoarticular and polyarticular forms of juvenile idiopathic arthritis who discontinue biologic therapy before 2 years from remission have a high likelihood of disease relapse.

Children with oligoarticular and polyarticular forms of juvenile idiopathic arthritis (JIA) who discontinue biologic therapy before 2 years from remission have a high likelihood of disease relapse, according to the results of a multicenter, retrospective analysis published in Arthritis Care & Research.

The investigators sought to evaluate the time patients were in remission after discontinuing biologic therapy for the treatment of JIA. The primary study outcome was to assess, once remission had been attained, the time in remission up to the first disease flare after treatment withdrawal.

A total of 135 patients with JIA were enrolled in the study. Median patient age was 14.6 years (range, 3.2 to 16.8 years). Overall, 104 of the participants were women and 31 were men.

There were 87 participants treated with etanercept, 27 with adalimumab, 12 with infliximab, 7 with anakinra, 1 with rituximab, and 1 with abatacept. Each agent was administered at the standard dose for a median of 20 months (range, 7 to 146 months). Moreover, 68.1% (92 of 104) of the children also received methotrexate (MTX) 10 to 15 mg/m2 every week.

After discontinuing biologic therapy, 75.6% (102 of 135) of the participants experienced flares, with a median follow-up time in remission off therapy of 6 months (range, 3 to 109 months). Of enrolled patients who flared, 34.1% restarted the same biologic agent, 19.3% switched to another biologic, 4.4% reinitiated MTX, 11.9% received intra-articular corticosteroid injections, 2.2% received no treatment, and 0.7% were treated with another antirheumatic medication.

A significantly greater likelihood of maintaining remission after discontinuation of biologic therapy was reported in systemic-onset disease compared with the rest of the patients with JIA (P <.004).

In an analysis of children with oligoarticular and polyarticular JIA, children who received biologic agents for >2 years after achieving remission had a significantly higher probability of maintaining this remission without therapy compared with children who received biologic therapy for <2 years (18.64±3.3 months vs 11.51±2.7 months, respectively; P <.009).

The results of this study suggest that biologic therapy among patients in selected JIA categories should be continued for ≥2 years after attaining clinical remission.

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Reference

Simonini G, Ferrara G, Pontikaki I, et al. Flares after withdrawal of biologic therapies in juvenile idiopathic arthritis: clinical and laboratory correlates of remission duration [published online October 3, 2017; April 24, 2018].  Arthritis Care Res (Hoboken). doi: 10.1002/acr.23435

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