Pos1327 do Jia Patients Response to Re-Treatment After a Flare During Tapering of Bdmards? A Descriptive Study

Abstract

Background:Tapering and withdrawal of biological DMARDs (bDMARDs) is often attempted in Juvenile Idiopathic Arthritis (JIA) patients but data about response to re-treatment after an unsuccessful tapering are scarce.Objectives:Our aim is to assess response to re-treatment after a disease flare during tapering or withdrawal of bDMARDs and to describe re-treatment strategies.Methods:A retrospective, descriptive study was conducted in a cohort of JIA patients followed up in a referral hospital and who had received bDMARDs between 2000 and 2019. All JIA patients with at least one flare during tapering or withdrawal were included. Response to re-treatment was defined as achieving Wallace criteria for remission for 6 months.Results:A total of 142 flares during tapering or withdrawal were identified and included. In 3/142 (2.1%) patients bDMARDS were not re-started after a flare, 1 due to patient refusal, 2 due to unplanned pregnancy. Main characteristics according to tapering strategies are reported in Table 1.Table 1.Main characteristics according to tapering strategies. Apso, Psoriatic Arthritis; ERA, Enthesitis related Arthritis; OligE, Oligoarticular Extended; OligP, oligoarticular persistent; Poly RF+, polyarticular rheumatoid factor positive; PolyRF-, polyarticular rheumatoid factor negative; sJIA, Systemic JIA; Und, Undifferenciated.TaperingWithdrawalCases, n (%)80 (57.5)59 (42.4)Female, n (%)57 (71.3)36 (61)Age at diagnosis,years, median (IQR)5 (2-11)4 (2-11)Age at start of tapering or withdrawal, years, median (IQR)17 (11-25)16 (8-29)Categories, n (%)OligP19 (23.8)12 (20.3)OligE15 (18.8)13 (22)sJIA10 (12.5)11 (18.6)ERA12 (15)8 (13.6)Apso7 (8.8)6 (10.2)Poly RF+9 (11.3)4 (6.8)Poly RF-7 (8.8)3 (5.1)Und1 (1.3)2 (3.4)Uveitis, n (%)24 (30)16 (27.1)Laboratory values, n (%)- RF15 (18.8)5 (8.5)- ANA45 (56.3)33 (55.9)cDMARDs at start of tapering, n (%)40 (50)20 (33.9)bDMARD target, n (%)- TNF inhibitors63 (78.8)45 (76.3)- IL6-blockers14 (17.5)5 (8.5)- IL1-blockers2 (2.5)7 (11.9)- Rituximab1 (1.3)2 (3.4)Line of bDMARD, n (%)- First50 (62.5)45 (76.3)- Second18 (22.5)10 (16.9)- Third5 (6.3)2 (3.4)- Forth6 (7.5)2 (3.4)- Fifth1 (1.3)0 (0)Time in bDMARD treatment, months median (IQR)28.4 (13.3-52.5)28.2 (13.9-44.6)Remission prior tapering or withdrawal,months median (IQR)8 (6-12)8 (6-12)Fifty-nine out of 80 (73.8%) tapering cases were on remission at 6 months (6m) and 42/80 (52.5%) at 12 months (12m). Regarding dosage schedule adjustments, interval widening was the most frequent in 70/80 (87.5%) followed by combined strategy in 7/80 (8.8%) and lower dosage in 3/80 (3.8%). Median remaining dosage administrated was 54.9% IQR(50-75). Median time to flare was 14.9 months IQR (5.6-24.7). Median time to re-start of bDMARDs was 0 months min-max(0-13).After withdrawal of bDMARDs 23/59 (39%)cases at 6m and 14/59 (23.7%) cases at 12m were on remission. Median time to flare was 4.7 months IQR (2.8-11.4). Median time to re-start of bDMARDs was 1 month min-max (1-6).Most frequent re-treatment strategies were re-start of standard dosage [tapering 42/80 (52.5%), withdrawal 34/59 (57.6%)], re-start of previous effective dosage [tapering 28/80 (35%), withdrawal 11/59 (18.6%)], change of bDMARD [tapering 6/80 (7.5%), withdrawal 6/59 (10.2), re-start of bDMARD and cDMARD [tapering 4/80 (5%), withdrawal 6/59 (10.2)] and re-start of cDMARD [tapering 0/80 (0), withdrawal 1/59 (1.7%)].Overall response to re-treatment was 75/80 (93.8%) and 53/58 (91.4%) among tapering and withdrawal, respectively. In 12/139 (8.6%) patients bDMARD was changed, achieving remission in 11/12 (91.7%) cases. No factors were associated with response to re-treatment and there were no differences between re-treatment strategies and re-achieving remission (p=0.596).Conclusion:Response to re-treatment was high (92.7%), no risk factors were identified. Most frequent retreatment strategy was re-start of standard bDMARD dosage in 76/139 (54.7%) followed up by restart of previous effective bDMARD dosage in 39/139 (28.1%).Disclosure of Interests:None declared