Risk, Timing, and Predictors of Disease Flare After Discontinuation of Anti-Tumor Necrosis Factor Therapy in Children With Polyarticular Forms of Juvenile Idiopathic Arthritis With Clinically Inactive Disease.
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Lovell Daniel J, Johnson Anne L, Huang Bin, Gottlieb Beth S, Morris Paula W, Kimura Yukiko, Onel Karen, Li Suzanne C, Grom Alexei A, Taylor Janalee, Brunner Hermine I, Huggins Jennifer L, Nocton James J, Haines Kathleen A, Edelheit Barbara S, Shishov Michael, Jung Lawrence K, Williams Calvin B, Tesher Melissa S, Costanzo Denise M, Zemel Lawrence S, Dare Jason A, Passo Murray H, Ede Kaleo C, Olson Judyann C, Cassidy Elaine A, Griffin Thomas A, Wagner-Weiner Linda, Weiss Jennifer E, Vogler Larry B, Rouster-Stevens Kelly A, Beukelman Timothy, Cron Randy Q, Kietz Daniel, Schikler Kenneth, Schmidt Kara M, Mehta Jay, Wahezi Dawn M, Ting Tracy V, Verbsky James W, Eberhard B Anne, Spalding Steven, Chen Chen, Giannini Edward H
Аннотация
METHODS: In 16 centers 137 patients with clinically inactive JIA who were receiving anti-TNF therapy (42% of whom were also receiving methotrexate [MTX]) were prospectively followed up. If the disease remained clinically inactive for the initial 6 months of the study, anti-TNF was stopped and patients were assessed for flare at 1, 2, 3, 4, 6, and 8 months. Life-table analysis, t-tests, chi-square test, and Cox regression analysis were used to identify independent variables that could significantly predict flare by 8 months or time to flare.
RESULTS: Of 137 patients, 106 (77%) maintained clinically inactive disease while receiving anti-TNF therapy for the initial 6 months and were included in the phase of the study in which anti-TNF therapy was stopped. Stopping anti-TNF resulted in disease flare in 39 (37%) of 106 patients by 8 months. The mean/median ± SEM time to flare was 212/250 ± 9.77 days. Patients with shorter disease duration at enrollment, older age at onset and diagnosis, shorter disease duration prior to experiencing clinically inactive disease, and shorter time from onset of clinically inactive disease to enrollment were found to have significantly lower hazard ratios for likelihood of flare by 8 months (P < 0.05).
CONCLUSION: Over one-third of patients with polyarticular JIA with sustained clinically inactive disease will experience a flare by 8 months after discontinuation of anti-TNF therapy. Several predictors of lower likelihood of flare were identified.