Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis

Clinical and Laboratory Correlates of Remission Duration

Gabriele Simonini, Giovanna Ferrara, Irene Pontikaki, Erika Scoccimarro, Teresa Giani, Andrea Taddio, Pier Luigi Meroni, Rolando Cimaz

Research output: Contribution to journalArticle

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Abstract

Objective: To assess the time in remission after discontinuing biologic therapy in patients with juvenile idiopathic arthritis (JIA). Methods: We enrolled 135 patients followed in 3 tertiary-care centers. The primary outcome was to assess, once remission was achieved, the time in remission up to the first flare after discontinuing treatment. Mann-Whitney U test, Wilcoxon's signed rank test for paired samples, chi-square tests, and Fisher's exact test were used to compare data. Pearson's and Spearman's correlation tests were used to determine correlation coefficients for different variables. To identify predictors of outcome, Cox regression model and Kaplan-Meier curves were constructed, each one at the mean of entered covariates. Results: The majority of enrolled patients flared after stopping treatment with biologics (102 of 135, 75.6%) after a median followup time in remission off therapy of 6 months (range 3–109 months). A higher probability of maintaining remission after discontinuing treatment was present in systemic-onset disease compared to the rest of the JIA patients (Mantel-Cox χ2 = 8.31, P < 0.004). In analysis limited to children with JIA with polyarticular and oligoarticular disease, patients who received biologics >2 years after achieving remission had a higher probability of maintaining such remission off therapy (mean ± SD 18.64 ± 3.3 months versus 11.51 ± 2.7 months [P < 0.009]; Mantel-Cox χ2 = 9.06, P < 0.002). No other clinical variable was significantly associated with a long-lasting remission. Conclusion: Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal.

Original languageEnglish
Pages (from-to)1046-1051
Number of pages6
JournalArthritis Care and Research
Volume70
Issue number7
DOIs
Publication statusPublished - Jul 1 2018

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Biological Therapy
Juvenile Arthritis
Nonparametric Statistics
Therapeutics
Chi-Square Distribution
Biological Products
Proportional Hazards Models
Tertiary Care Centers

ASJC Scopus subject areas

  • Rheumatology

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Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis : Clinical and Laboratory Correlates of Remission Duration. / Simonini, Gabriele; Ferrara, Giovanna; Pontikaki, Irene; Scoccimarro, Erika; Giani, Teresa; Taddio, Andrea; Meroni, Pier Luigi; Cimaz, Rolando.

In: Arthritis Care and Research, Vol. 70, No. 7, 01.07.2018, p. 1046-1051.

Research output: Contribution to journalArticle

Simonini, Gabriele ; Ferrara, Giovanna ; Pontikaki, Irene ; Scoccimarro, Erika ; Giani, Teresa ; Taddio, Andrea ; Meroni, Pier Luigi ; Cimaz, Rolando. / Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis : Clinical and Laboratory Correlates of Remission Duration. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 7. pp. 1046-1051.
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abstract = "Objective: To assess the time in remission after discontinuing biologic therapy in patients with juvenile idiopathic arthritis (JIA). Methods: We enrolled 135 patients followed in 3 tertiary-care centers. The primary outcome was to assess, once remission was achieved, the time in remission up to the first flare after discontinuing treatment. Mann-Whitney U test, Wilcoxon's signed rank test for paired samples, chi-square tests, and Fisher's exact test were used to compare data. Pearson's and Spearman's correlation tests were used to determine correlation coefficients for different variables. To identify predictors of outcome, Cox regression model and Kaplan-Meier curves were constructed, each one at the mean of entered covariates. Results: The majority of enrolled patients flared after stopping treatment with biologics (102 of 135, 75.6{\%}) after a median followup time in remission off therapy of 6 months (range 3–109 months). A higher probability of maintaining remission after discontinuing treatment was present in systemic-onset disease compared to the rest of the JIA patients (Mantel-Cox χ2 = 8.31, P < 0.004). In analysis limited to children with JIA with polyarticular and oligoarticular disease, patients who received biologics >2 years after achieving remission had a higher probability of maintaining such remission off therapy (mean ± SD 18.64 ± 3.3 months versus 11.51 ± 2.7 months [P < 0.009]; Mantel-Cox χ2 = 9.06, P < 0.002). No other clinical variable was significantly associated with a long-lasting remission. Conclusion: Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal.",
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AU - Pontikaki, Irene

AU - Scoccimarro, Erika

AU - Giani, Teresa

AU - Taddio, Andrea

AU - Meroni, Pier Luigi

AU - Cimaz, Rolando

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N2 - Objective: To assess the time in remission after discontinuing biologic therapy in patients with juvenile idiopathic arthritis (JIA). Methods: We enrolled 135 patients followed in 3 tertiary-care centers. The primary outcome was to assess, once remission was achieved, the time in remission up to the first flare after discontinuing treatment. Mann-Whitney U test, Wilcoxon's signed rank test for paired samples, chi-square tests, and Fisher's exact test were used to compare data. Pearson's and Spearman's correlation tests were used to determine correlation coefficients for different variables. To identify predictors of outcome, Cox regression model and Kaplan-Meier curves were constructed, each one at the mean of entered covariates. Results: The majority of enrolled patients flared after stopping treatment with biologics (102 of 135, 75.6%) after a median followup time in remission off therapy of 6 months (range 3–109 months). A higher probability of maintaining remission after discontinuing treatment was present in systemic-onset disease compared to the rest of the JIA patients (Mantel-Cox χ2 = 8.31, P < 0.004). In analysis limited to children with JIA with polyarticular and oligoarticular disease, patients who received biologics >2 years after achieving remission had a higher probability of maintaining such remission off therapy (mean ± SD 18.64 ± 3.3 months versus 11.51 ± 2.7 months [P < 0.009]; Mantel-Cox χ2 = 9.06, P < 0.002). No other clinical variable was significantly associated with a long-lasting remission. Conclusion: Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal.

AB - Objective: To assess the time in remission after discontinuing biologic therapy in patients with juvenile idiopathic arthritis (JIA). Methods: We enrolled 135 patients followed in 3 tertiary-care centers. The primary outcome was to assess, once remission was achieved, the time in remission up to the first flare after discontinuing treatment. Mann-Whitney U test, Wilcoxon's signed rank test for paired samples, chi-square tests, and Fisher's exact test were used to compare data. Pearson's and Spearman's correlation tests were used to determine correlation coefficients for different variables. To identify predictors of outcome, Cox regression model and Kaplan-Meier curves were constructed, each one at the mean of entered covariates. Results: The majority of enrolled patients flared after stopping treatment with biologics (102 of 135, 75.6%) after a median followup time in remission off therapy of 6 months (range 3–109 months). A higher probability of maintaining remission after discontinuing treatment was present in systemic-onset disease compared to the rest of the JIA patients (Mantel-Cox χ2 = 8.31, P < 0.004). In analysis limited to children with JIA with polyarticular and oligoarticular disease, patients who received biologics >2 years after achieving remission had a higher probability of maintaining such remission off therapy (mean ± SD 18.64 ± 3.3 months versus 11.51 ± 2.7 months [P < 0.009]; Mantel-Cox χ2 = 9.06, P < 0.002). No other clinical variable was significantly associated with a long-lasting remission. Conclusion: Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal.

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