Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Clinical Outcomes after Withdrawal of Anti-Tumor Necrosis Factor-Alpha Therapy in Juvenile Idiopathic Arthritis: A Twelve-Year Experience.

Baszis2,  Kevin W., Toib2,  Dana, Brasington1,  Richard, King3,  Allison, Mao3,  Jingnan, White2,  Andrew J., Garbutt3,  Jane

Washington Univ Schl of Med, St Louis, MO
Washington University School of Medicine, Department of Pediatrics, St Louis, MO
Washington University School of Medicine, Department of Pediatrics

Objective:

To determine length of time to flare and likelihood of clinical remission after discontinuation of tumor necrosis factor-alpha (TNF-a) blockers in patients with juvenile idiopathic arthritis (JIA).

Methods:

This is a retrospective cohort review of 241 patients with JIA treated with TNF-a inhibitors at our center between January 1, 1998, and November 1, 2009. Primary outcomes were time to flare after withdrawal of TNF-a inhibitor and proportion of treatment episodes resulting in clinical remission after cessation of anti-TNF-a therapy. Time points of interest were based on preliminary criteria for inactive disease and remission in JIA1. Inactive disease (ID) is defined by no active arthritis/uveitis, no systemic symptoms or elevated ESR/CRP attributable to JIA, and physician global assessment indicating no disease activity. Clinical remission on medication (CRM) is defined by ID for 6 months, on medication. Clinical remission (CR) is defined by ID for 12 months while off all anti-arthritis/uveitis medications. For our purposes, patients were not excluded if remaining on anti-rheumatic drugs after stopping anti-TNF-a therapy, but any further use of corticosteroids or biologic agents was cause for exclusion. Descriptive statistics, survival analyses, and hazard ratios were calculated.

Results:

One hundred seventy-one patients met inclusion criteria, yielding 255 discrete episodes of anti-TNF-a treatment. Two hundred thirteen (83.5%) episodes resulted in ID; 127 (49.8%) episodes achieved CRM. After cessation of anti-TNF-a therapy in patients with ID, 50% of episodes remained in ID at 6 months, and 32% of episodes achieved CR off of anti-TNF-a therapy.

The median duration of anti-TNF-a therapy after ID was obtained was 6.1 months; there was no correlation between this duration and time to flare (r=0.01, p=0.91). Using hazard ratios and covariance analysis, subtype of JIA, sex, and age at diagnosis did not significantly affect risk of relapse. Median patient observation was 59.7 months.

Conclusion:

In 171 patients with JIA achieving inactive disease on TNF-a inhibitors, 50% remained in remission at 6 months and 33% at one year. Results did not significantly vary by JIA subtype, sex, age at diagnosis, or duration of therapy. Although these results support the observation that JIA is a chronic relapsing/remitting disease, they suggest that one-third of patients can be successfully withdrawn from TNF-a antagonists for at least one year and be spared the cost and potential morbidity of treatment. Further studies are needed to identify predictive factors for those patients who successfully obtain clinical remission after anti-TNF-a cessation.

References:

1.Wallace, CA, Ruperto, N & Giannini, EH. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol. 2004;31:2290-4.

To cite this abstract, please use the following information:
Baszis, Kevin W., Toib, Dana, Brasington, Richard, King, Allison, Mao, Jingnan, White, Andrew J., et al; Clinical Outcomes after Withdrawal of Anti-Tumor Necrosis Factor-Alpha Therapy in Juvenile Idiopathic Arthritis: A Twelve-Year Experience. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :216
DOI: 10.1002/art.27985

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