Withdrawal of biologic therapy in juvenile idiopathic arthritis due to remission: predictors of flare and outcomes

ABSTRACT

Objectives

To investigate patients who flared after discontinuation of biological disease-modifying anti-rheumatic agents (bDMARDs) and identify risk factors associated with flare.

Methods

A multicenter study evaluating systemic and non-systemic juvenile idiopathic arthritis (sJIA and non-sJIA) patients whose bDMARDs were ceased after remission.

Results

A total of 101 patients whose bDMARDs were ceased after remission was evaluated. Children with sJIA had the lowest risk of flare and 11.1% of 36 sJIA patients experienced flare after a median of 9 (4–24) months of bDMARDs cessation with three of them flaring in the first year. High leukocyte counts in sJIA patients were associated with inactive disease at 1-year after the start of treatment (p = 0.004). In the non-sJIA group, 46.1% patients experienced flare after a median of 7 (1–32) months of biologic cessation, and of these, 25 flared in the first year. Antinuclear antibody positivity (p = 0.02), earlier disease onset (p = 0.03), long disease duration (p = 0.01), and follow-up (p = 0.02) and extended time from diagnosis to first biological onset (p = 0.03) were more common among patients with flare.

Conclusions

When considering discontinuation of bDMARDs, it should be kept in mind that the risk of exacerbation requiring re-initiation therapy is quite significant within the first year after discontinuation of therapy.

KEYWORDS:

• bDMARDs
• discontinuation
• inactive disease
• juvenile idiopathic arthritis
• remission

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics statement

This study was approved by the Institutional Review Board of the University of Health Sciences, Umraniye Training and Research Hospital (approval number: 54132726-000-12265). Data was provided in an anonymous format by the Pediatric Rheumatology Academy-Research Group (PeRA-RG). Data was obtained from patients/parents of patients who had provided written consent approving use of their anonymized data for academic purposes.

Author contributions

A Tanatar and N Aktay Ayaz conceptualized and designed the study, drafted the initial manuscript, and had full access to all the data in the study; A Tanatar, O Akgün and HE Sönmez conducted the data analyses, drafted the initial manuscript, and had full access to all the data in the study; S Çağlayan, E Bağlan, GO Yener, K Öztürk, M Çakan and B Sözeri performed the data acquisition and contributed to writing the manuscript. All authors reviewed and revised the manuscript and approved the final version of the manuscript. N Aktay Ayaz accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14712598.2023.2185132

Additional information

Funding

This paper was not funded.