Ab0734 remission in Juvenile Idiopathic Arthritis After Withdrawal of Systemic Treatment

Abstract

Background:Juvenile idiopathic arthritis (JIA) requires frequent systemic treatments, the ideal goal being to achieve remission. Questions remain as to when treatment can be stopped and how to balance the risks and benefits of continuing medications against the possibility of a flare after discontinuation. There is currently little conclusive evidence on the management of JIA in remission.Objectives:To determine the time to remission and frequency of flares in patients with JIA after withdrawal of systemic treatment in a single-centre cohort.Methods:Patients with JIA visited in the last 15 years were included. A retrospective cross-sectional study was performed. Demographic data such as sex, age at diagnosis, current age, subcategories of JIA were collected. Systemic treatment was also collected (date of discontinuation, date of flare after discontinuation, time in remission, time of treatment until discontinuation, discontinuation of biologic therapy while maintaining methotrexate). For the analysis of qualitative variables, absolute and relative frequencies were used; for quantitative variables, median and IR; for comparative analysis, Chi-square and Mann-Whitney U test.Results:We included 146 patients with JIA. Demographic data are shown in Table 1. 134 (90.4%) patients required systemic treatment (synthetic and/or biological DMARDs), of which 61 (45.5%) discontinued treatment completely at some point. Of the total number of patients who discontinued all systemic treatment, 19 (31.1%) had a flare with a median time in remission of 4.1 years (IR 1.3-9.1). 17 of the 134 patients (12.7%) with systemic treatment discontinued biologic therapy while maintaining methotrexate, of which 12 (70.6%) patients had a flare with a median time in remission of 0.9 years (IR 0.6-1.2). The differences between the frequency of flares and median time in remission between both treatment discontinuation groups (all systemic treatment versus discontinuation of biologic while maintaining methotrexate) were statistically significant (p<0.001). The median time from systemic treatment to complete withdrawal was 3.2 years (IR 1.9-4.8).Table 1.Demographic characteristics of patients with JIAVariables N 146Sex: Women n (%) 89 (60.3)Age at onset (years, median (IR)) 4.6 (2.5-9.2)Current age (years, median (IR))16.7 (11.1-20.9)Types of JIA:Persistent oligoarticular n (%) 66 (45.2)Extended oligoarticular n (%) 11 (7.5)Polyarticular RF - n (%) 29 (19.9)Polyarticular RF + n (%) 3 (2.1)Enthesitis-related n (%) 12 (8.2)Psoriatic n (%) 9 (6.2)Systemic n (%) 16 (11.0)Conclusion:One third of the patients in whom all systemic treatment was withdrawn had a flare (70% remain in remission without medication) with a median time in remission of 4 years. On the other hand, two-thirds of patients in whom biologic therapy was withdrawn while maintaining methotrexate had a flare, with a shorter time in remission. The differences between both groups with withdrawal of systemic treatment are statistically significant (p<0.001).References:[1]Halyabar O, Mehta J, Ringold S, Rumsey DG, Horton DB. Treatment Withdrawal Following Remission in Juvenile Idiopathic Arthritis: A Systematic Review of the Literature. Paediatr Drugs. 2019 Dec;21(6):469-492. doi: 10.1007/s40272-019-00362-6.[2]Simonini G, Ferrara G, Pontikaki I, Scoccimarro E, Giani T, Taddio A, Meroni PL, Cimaz R. Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis: Clinical and Laboratory Correlates of Remission Duration. Arthritis Care Res (Hoboken). 2018 Jul;70(7):1046-1051. doi: 10.1002/acr.23435.[3]Chhabra A, Robinson C, Houghton K, Cabral DA, Morishita K, Tucker LB, Petty RE, Larché M, Batthish M, Guzman J. Long-term outcomes and disease course of children with juvenile idiopathic arthritis in the ReACCh-Out cohort: a two-centre experience. Rheumatology (Oxford). 2020 Dec 1;59(12):3727-3730. doi: 10.1093/rheumatology/keaa118.Disclosure of Interests:None declared