Support for continuing biologic treatment beyond 2 years following JIA remission
medwireNews: Children with oligoarticular or polyarticular juvenile idiopathic arthritis (JIA) who stop biologic treatment within 2 years of achieving remission have an increased risk for relapse compared with those who continue treatment for a longer period, researchers report.
Rolando Cimaz (University of Florence, Italy) and study co-authors analyzed data from 135 children with JIA who were treated with biologics for a median period of 20 months. The majority (64.4%) of participants were treated with etanercept, followed by adalimumab (20.0%), infliximab (8.9%), and anakinra (5.2%).
Three quarters (75.6%) of patients experienced flares after stopping treatment with biologics, and the median time spent in remission following biologic cessation was 6 months. When the participants were categorized according to JIA subtype, children with systemic-onset disease were significantly more likely to stay in remission than those with other types of JIA, with approximately 60% of systemic-onset JIA patients being remission-free 80 months after discontinuing treatment, versus approximately 18% of those with polyarticular JIA and 10% of those with oligoarticular extended disease.
In an analysis of factors associated with remission after cessation of treatment, which was limited to the 106 children with oligoarticular or polyarticular JIA, receipt of biologics for more than 2 years after remission was identified as a significant predictor of continued remission. Those who were treated for longer than this cutoff time remained flare-free for a mean of 18.64 months after stopping therapy, compared with 11.51 months for those who were treated for less than 2 years.
One of the most common questions I am asked by parents is how long their child will need to take medications.
However, cutoff times of 6, 12, and 18 months on biologic therapy were not found to be significant predictors of maintained remission, and antinuclear antibody (ANA) positivity was not associated with higher risk for flare, note the authors.
“These data seem to suggest that biologic treatment, in selected JIA categories, might be continued for at least 2 years after achieving clinical remission,” write Cimaz and colleagues in Arthritis Care & Research.
They explain that “since the number of patients in certain JIA subtypes was too small to draw reliable conclusions,” predictors of remission were only analyzed in participants with oligoarticular or polyarticular JIA as they were “more homogenous groups with an equal distribution of ANA positivity across them.”
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