@article {10579, title = {Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis: Clinical and Laboratory Correlates of Remission Duration.}, journal = {Arthritis Care Res (Hoboken)}, volume = {70}, year = {2018}, month = {2018 Jul}, pages = {1046-1051}, 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{\textquoteright}s signed rank test for paired samples, chi-square tests, and Fisher{\textquoteright}s exact test were used to compare data. Pearson{\textquoteright}s and Spearman{\textquoteright}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 χ = 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 {\textpm} SD 18.64 {\textpm} 3.3 months versus 11.51 {\textpm} 2.7 months [P < 0.009]; Mantel-Cox χ = 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.

}, issn = {2151-4658}, doi = {10.1002/acr.23435}, author = {Simonini, Gabriele and Ferrara, Giovanna and Pontikaki, Irene and Scoccimarro, Erika and Giani, Teresa and Taddio, Andrea and Meroni, Pier Luigi and Cimaz, Rolando} }