Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis: Clinical and Laboratory Correlates of Remission Duration

OBJECTIVE: to assess the time in remission after discontinuing biologic therapy in JIA patients.

METHODS: we enrolled 135 patients followed in three tertiary care centers. Primary outcome was to assess, once remission was achieved, the time in remission up to the first flare after discontinuing treatment. Mann-Whitney U-test, Wilcoxon signed-rank test for paired samples, chi-square, and Fisher's exact test were used to compare data. Pearson and Spearman correlation tests were used to determine correlation coefficients for different variables. In order to identify predictors of outcome Cox regression model and Kaplan-Meier curves were constructed, each one at mean of entered covariates.

RESULTS: The majority of enrolled patients flared after stopping treatment with biologics (102/135, 75.6%) after a median follow-up time in remission off therapy of 6 months (range 3-109). A higher probability of maintaining remission after discontinuing treatment was present in systemic onset disease compared to the rest of JIA patients (Mantel-Cox χ28.31, p<0.004). In analysis limited to JIA children with polyarticular and oligoarticular disease, patients who received biologics > 2 years after achieving remission had a higher probability of maintaining such remission off therapy (18.64 ±3.3 months vs 11.51 ±2.7, p<0.009; Mantel-Cox χ2 9.06, p<0.002). No other clinical variable resulted significantly associated with a long-lasting remission.

CONCLUSION: Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal. This article is protected by copyright. All rights reserved.