Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Risk of Relapse After Discontinuation of Medications in Patients with Polyarticular Course Juvenile Idiopathic Arthritis
Milojevic1, Diana, Curran1, Megan L., Gottlieb2, Beth S.
Two goals of medical treatment in juvenile idiopathic arthritis (JIA) are to achieve remission of the disease and minimize medication toxicity. Discontinuation of medications during disease quiescence decreases cumulative toxicity. It is not known if the type of treatment used to achieve clinical remission on medications (CRM) affects the subsequent duration of inactive disease off medications in polyarticular JIA. In this study, we compare the risk of relapse during inactive disease off medications in polyarticular course JIA patients who achieved CRM with methotrexate versus methotrexate and etanercept.
This is a retrospective study of 64 JIA patients who achieved CRM and were subsequently taken off all medications. They belonged to one of the following four sub-types of JIA as defined by ILAR criteria: extended oligoarticular, psoriatic, polyarticular rheumatoid factor (RF) negative and polyarticular RF positive. Group 1 consisted of 26 patients treated with methotrexate and followed from 1995 to 2000, prior to the introduction of etanercept into clinical practice. Groups 2 and 3 were patients followed from 2003 to 2008, treated with methotrexate alone (22 patients, group 2) or with methotrexate and etanercept (16 patients, group 3). The Wallace Criteria were used to define CRM. All patients achieved CRM and were taken off all medications after one year of inactive disease. Relapse was defined as persistent arthritis in at least one joint for at least 6 weeks.
Patients treated with the combination of methotrexate and etanercept (group 3) had significantly more active joints (p <0.001) and significantly higher weekly and cumulative methotrexate dosages (p= 0.02 and p=0.009, respectively). On average, prior to achieving CRM, patients in group 3 were treated with methotrexate for 23 months and etanercept for 6.2 months, while group 1 patients were treated with methotrexate for 8.7 months and group 2 patients for 16 months. Type of treatment did not significantly affect the risk of relapse in the three groups (p= 0.56), although compared to group 1, the risk in group 2 was 4% lower (HR 0.96, 95% CI 0.45, 2.04) and in group 3 was 49% higher (HR 1.49, 95% CI 0.66, 3.35). The risk of relapse did not significantly change after adjusting for age, gender, sub-type of JIA, number of affected joints, weekly and cumulative dosages of methotrexate, time from diagnosis to treatment and duration of methotrexate treatment.
Our results indicate that treatment with methotrexate and etanercept compared to treatment with methotrexate alone does not significantly affect the risk of relapse in patients with polyarticular course JIA who achieved CRM and were off all medications. However, patients treated with methotrexate and etanercept had more severe disease, indicated by more active joints and longer duration of methotrexate treatment prior to achieving remission.
To cite this abstract, please use the following information:
Milojevic, Diana, Curran, Megan L., Gottlieb, Beth S.; Risk of Relapse After Discontinuation of Medications in Patients with Polyarticular Course Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :246