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

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Abstract

OBJECTIVE: to assess the time in remission after discontinuing biologic therapy in JIA patients.

METHODS: we enrolled 135 patients followed in three tertiary care centers. 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 signed-rank test for paired samples, chi-square, and Fisher's exact test were used to compare data. Pearson and Spearman correlation tests were used to determine correlation coefficients for different variables. In order to identify predictors of outcome Cox regression model and Kaplan-Meier curves were constructed, each one at mean of entered covariates.

RESULTS: The majority of enrolled patients flared after stopping treatment with biologics (102/135, 75.6%) after a median follow-up time in remission off therapy of 6 months (range 3-109). A higher probability of maintaining remission after discontinuing treatment was present in systemic onset disease compared to the rest of JIA patients (Mantel-Cox χ28.31, p<0.004). In analysis limited to JIA children with polyarticular and oligoarticular disease, patients who received biologics > 2 years after achieving remission had a higher probability of maintaining such remission off therapy (18.64 ±3.3 months vs 11.51 ±2.7, p<0.009; Mantel-Cox χ2 9.06, p<0.002). No other clinical variable resulted 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. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)1046-1051
Number of pages6
JournalArthritis Care & Research
Volume70
Issue number7
Early online date3 Oct 2017
DOIs
Publication statusPublished - Jul 2018

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Biological Therapy
Juvenile Arthritis
Nonparametric Statistics
Therapeutics
Biological Products
Proportional Hazards Models
Tertiary Care Centers

Keywords

  • Journal Article

Cite this

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 & Research, Vol. 70, No. 7, 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 & 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 JIA patients.METHODS: we enrolled 135 patients followed in three tertiary care centers. 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 signed-rank test for paired samples, chi-square, and Fisher's exact test were used to compare data. Pearson and Spearman correlation tests were used to determine correlation coefficients for different variables. In order to identify predictors of outcome Cox regression model and Kaplan-Meier curves were constructed, each one at mean of entered covariates.RESULTS: The majority of enrolled patients flared after stopping treatment with biologics (102/135, 75.6{\%}) after a median follow-up time in remission off therapy of 6 months (range 3-109). A higher probability of maintaining remission after discontinuing treatment was present in systemic onset disease compared to the rest of JIA patients (Mantel-Cox χ28.31, p<0.004). In analysis limited to JIA children with polyarticular and oligoarticular disease, patients who received biologics > 2 years after achieving remission had a higher probability of maintaining such remission off therapy (18.64 ±3.3 months vs 11.51 ±2.7, p<0.009; Mantel-Cox χ2 9.06, p<0.002). No other clinical variable resulted 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. This article is protected by copyright. All rights reserved.",
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author = "Gabriele Simonini and Giovanna Ferrara and Irene Pontikaki and Erika Scoccimarro and Teresa Giani and Andrea Taddio and Meroni, {Pier Luigi} and Rolando Cimaz",
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year = "2018",
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T1 - Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis

T2 - Clinical and Laboratory Correlates of Remission Duration

AU - Simonini, Gabriele

AU - Ferrara, Giovanna

AU - Pontikaki, Irene

AU - Scoccimarro, Erika

AU - Giani, Teresa

AU - Taddio, Andrea

AU - Meroni, Pier Luigi

AU - Cimaz, Rolando

N1 - This article is protected by copyright. All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - OBJECTIVE: to assess the time in remission after discontinuing biologic therapy in JIA patients.METHODS: we enrolled 135 patients followed in three tertiary care centers. 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 signed-rank test for paired samples, chi-square, and Fisher's exact test were used to compare data. Pearson and Spearman correlation tests were used to determine correlation coefficients for different variables. In order to identify predictors of outcome Cox regression model and Kaplan-Meier curves were constructed, each one at mean of entered covariates.RESULTS: The majority of enrolled patients flared after stopping treatment with biologics (102/135, 75.6%) after a median follow-up time in remission off therapy of 6 months (range 3-109). A higher probability of maintaining remission after discontinuing treatment was present in systemic onset disease compared to the rest of JIA patients (Mantel-Cox χ28.31, p<0.004). In analysis limited to JIA children with polyarticular and oligoarticular disease, patients who received biologics > 2 years after achieving remission had a higher probability of maintaining such remission off therapy (18.64 ±3.3 months vs 11.51 ±2.7, p<0.009; Mantel-Cox χ2 9.06, p<0.002). No other clinical variable resulted 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. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: to assess the time in remission after discontinuing biologic therapy in JIA patients.METHODS: we enrolled 135 patients followed in three tertiary care centers. 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 signed-rank test for paired samples, chi-square, and Fisher's exact test were used to compare data. Pearson and Spearman correlation tests were used to determine correlation coefficients for different variables. In order to identify predictors of outcome Cox regression model and Kaplan-Meier curves were constructed, each one at mean of entered covariates.RESULTS: The majority of enrolled patients flared after stopping treatment with biologics (102/135, 75.6%) after a median follow-up time in remission off therapy of 6 months (range 3-109). A higher probability of maintaining remission after discontinuing treatment was present in systemic onset disease compared to the rest of JIA patients (Mantel-Cox χ28.31, p<0.004). In analysis limited to JIA children with polyarticular and oligoarticular disease, patients who received biologics > 2 years after achieving remission had a higher probability of maintaining such remission off therapy (18.64 ±3.3 months vs 11.51 ±2.7, p<0.009; Mantel-Cox χ2 9.06, p<0.002). No other clinical variable resulted 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. This article is protected by copyright. All rights reserved.

KW - Journal Article

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DO - 10.1002/acr.23435

M3 - Article

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SP - 1046

EP - 1051

JO - Arthritis Care & Research

JF - Arthritis Care & Research

SN - 0893-7524

IS - 7

ER -