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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.

Authors:
Daniel J Lovell Anne L Johnson Bin Huang Beth S Gottlieb Paula W Morris Yukiko Kimura Karen Onel Suzanne C Li Alexei A Grom Janalee Taylor Hermine I Brunner Jennifer L Huggins James J Nocton Kathleen A Haines Barbara S Edelheit Michael Shishov Lawrence K Jung Calvin B Williams Melissa S Tesher Denise M Costanzo Lawrence S Zemel Jason A Dare Murray H Passo Kaleo C Ede Judyann C Olson Elaine A Cassidy Thomas A Griffin Linda Wagner-Weiner Jennifer E Weiss Larry B Vogler Kelly A Rouster-Stevens Timothy Beukelman Randy Q Cron Daniel Kietz Kenneth Schikler Kara M Schmidt Jay Mehta Dawn M Wahezi Tracy V Ting James W Verbsky B Anne Eberhard Steven Spalding Chen Chen Edward H Giannini

Arthritis Rheumatol 2018 09 25;70(9):1508-1518. Epub 2018 Jul 25.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Objective: To determine the frequency, time to flare, and predictors of disease flare upon withdrawal of anti-tumor necrosis factor (anti-TNF) therapy in children with polyarticular forms of juvenile idiopathic arthritis (JIA) who demonstrated ≥6 months of continuous clinically inactive disease.

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.

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http://dx.doi.org/10.1002/art.40509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115300PMC
September 2018

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