Angela Aquilani1,2, Denise Pires Marafon3,4, Emiliano Marasco3,4, Rebecca Nicolai3,4, Virginia Messia3,4, Francesca Perfetti3,4, Silvia Magni-Manzoni3,4, Fabrizio De Benedetti3,4. 1. From the Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, Institute for Research and Health Care (IRCCS), Rome, Italy. angela.aquilani@gmail.com. 2. A. Aquilani, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; D. Pires Marafon, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; E. Marasco, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; R. Nicolai, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; V. Messia, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; F. Perfetti, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; S. Magni-Manzoni, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; F. De Benedetti, MD, PhD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS. angela.aquilani@gmail.com. 3. From the Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, Institute for Research and Health Care (IRCCS), Rome, Italy. 4. A. Aquilani, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; D. Pires Marafon, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; E. Marasco, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; R. Nicolai, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; V. Messia, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; F. Perfetti, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; S. Magni-Manzoni, MD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS; F. De Benedetti, MD, PhD, Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS.
Abstract
OBJECTIVE: To evaluate the rate of flare after etanercept (ETN) withdrawal in patients with juvenile idiopathic arthritis (JIA) who attained clinical remission while taking medication, and to identify predictors of flare. METHODS: Patients were included with oligo- (oJIA) and rheumatoid factor-negative polyarticular JIA (pJIA) who received a first course of ETN for at least 18 months, maintained clinically inactive disease (CID) for at least 6 months during treatment, and were followed for 12 months after ETN withdrawal. Demographic and clinical features were collected at onset, at baseline (initiation of ETN), and at time of disease flare. RESULTS: After ETN withdrawal, 66 of the 110 patients enrolled (60%) flared with arthritis (of whom 7 flared with concurrent anterior uveitis; none with uveitis alone). The median time to flare was 4.3 months (interquartile range 2.5-6.4) with no evident differences between oJIA and pJIA. The number and type of joints involved at baseline and characteristics of ETN treatment/discontinuation were not associated with flare. Patients who flared were more frequently males (p = 0.034), positive for antinuclear antibody (ANA; p = 0.047), and had higher values of C-reactive protein (CRP; p = 0.012) at baseline. These variables remained significantly associated with flare in a multivariate logistic analysis, a model accounting for only 14% of the variability of the occurrence of the flare. CONCLUSION: Our results show that a significant proportion of patients with JIA who maintain CID for at least 6 months experience a relapse after ETN withdrawal. Male sex, presence of ANA, and elevated CRP at baseline were associated with higher risk of flare.
OBJECTIVE: To evaluate the rate of flare after etanercept (ETN) withdrawal in patients with juvenile idiopathic arthritis (JIA) who attained clinical remission while taking medication, and to identify predictors of flare. METHODS:Patients were included with oligo- (oJIA) and rheumatoid factor-negative polyarticular JIA (pJIA) who received a first course of ETN for at least 18 months, maintained clinically inactive disease (CID) for at least 6 months during treatment, and were followed for 12 months after ETN withdrawal. Demographic and clinical features were collected at onset, at baseline (initiation of ETN), and at time of disease flare. RESULTS: After ETN withdrawal, 66 of the 110 patients enrolled (60%) flared with arthritis (of whom 7 flared with concurrent anterior uveitis; none with uveitis alone). The median time to flare was 4.3 months (interquartile range 2.5-6.4) with no evident differences between oJIA and pJIA. The number and type of joints involved at baseline and characteristics of ETN treatment/discontinuation were not associated with flare. Patients who flared were more frequently males (p = 0.034), positive for antinuclear antibody (ANA; p = 0.047), and had higher values of C-reactive protein (CRP; p = 0.012) at baseline. These variables remained significantly associated with flare in a multivariate logistic analysis, a model accounting for only 14% of the variability of the occurrence of the flare. CONCLUSION: Our results show that a significant proportion of patients with JIA who maintain CID for at least 6 months experience a relapse after ETN withdrawal. Male sex, presence of ANA, and elevated CRP at baseline were associated with higher risk of flare.
Authors: Varvara Choida; Margaret Hall-Craggs; Bethany R Jebson; Corinne Fisher; Maria Leandro; Lucy R Wedderburn; Coziana Ciurtin Journal: Front Pharmacol Date: 2021-02-02 Impact factor: 5.810
Authors: Nisha R Acharya; Caleb D Ebert; Nicole K Kelly; Travis C Porco; Athimalaipet V Ramanan; Benjamin F Arnold Journal: Trials Date: 2020-10-27 Impact factor: 2.279
Authors: Anouk M Barendregt; Saskia R Veldkamp; Petra C E Hissink Muller; Annemarie van de Geer; Cathelijn Aarts; E Charlotte van Gulik; Marco W Schilham; Christoph Kessel; Mischa P Keizer; Robert Hemke; Amara Nassar-Sheikh Rashid; Koert M Dolman; Dieneke Schonenberg-Meinema; Rebecca Ten Cate; J Merlijn van den Berg; Mario Maas; Taco W Kuijpers Journal: Rheumatology (Oxford) Date: 2020-09-01 Impact factor: 7.580