Baszis Kevin, Garbutt Jane, Toib Dana, Mao Jingnan, King Allison, White Andrew, French Anthony
Washington University School of Medicine, Department of Pediatrics, St. Louis, Missouri 63110, USA.
Arthritis Rheum. 2011 Oct;63(10):3163-8. doi: 10.1002/art.30502.
To estimate the length of time to disease flare and the likelihood of achieving clinical remission after discontinuation of treatment with tumor necrosis factor α (TNFα) blockers in patients with juvenile idiopathic arthritis (JIA).
We conducted a retrospective chart review in a cohort of patients with JIA treated with TNFα inhibitors between January 1, 1998 and November 1, 2009. Demographic information, laboratory data, and medication exposure were extracted using a standardized tool. Outcomes of interest were based on preliminary criteria for remission in JIA.
One hundred seventy-one patients with 255 discrete episodes of anti-TNFα treatment were reviewed. The median duration of patient observation was 59.7 months (range 5.8-211.2 months). Among patients in whom disease was inactive after discontinuation of anti-TNFα therapy, 50% had persistently inactive disease at 6 months, and 33% had clinical remission at 12 months. The median duration of anti-TNFα therapy after inactive disease was obtained was 6.1 months (range 0-67.9 months). No significant association was observed between the time to disease flare after cessation of treatment with TNFα antagonists and the length of time from the diagnosis of JIA to the initiation of anti-TNFα therapy, the duration of therapy following the onset of inactive disease, or the total duration of treatment with TNFα antagonists prior to discontinuation. The category of JIA, sex, and age at diagnosis were not associated with the risk of relapse.
One-third of patients with JIA can successfully undergo withdrawal of treatment with TNFα antagonists and be spared the cost and potential morbidity of treatment for at least 12 months. Further studies are needed to identify factors to accurately identify these patients.
评估青少年特发性关节炎（JIA）患者停用肿瘤坏死因子α（TNFα）阻滞剂后疾病复发的时间以及实现临床缓解的可能性。
我们对1998年1月1日至2009年11月1日期间接受TNFα抑制剂治疗的JIA患者队列进行了回顾性病历审查。使用标准化工具提取人口统计学信息、实验室数据和药物暴露情况。感兴趣的结局基于JIA缓解的初步标准。
对171例患者的255次抗TNFα治疗离散发作进行了审查。患者观察的中位持续时间为59.7个月（范围5.8 - 211.2个月）。在停用抗TNFα治疗后疾病无活动的患者中，50%在6个月时疾病持续无活动，33%在12个月时实现临床缓解。疾病无活动后抗TNFα治疗的中位持续时间为6.1个月（范围0 - 67.9个月）。在停用TNFα拮抗剂治疗后疾病复发的时间与从JIA诊断到开始抗TNFα治疗的时间、疾病无活动发作后的治疗持续时间或停用前TNFα拮抗剂的总治疗持续时间之间未观察到显著关联。JIA的类别、性别和诊断时的年龄与复发风险无关。
三分之一的JIA患者可以成功停用TNFα拮抗剂治疗，并且至少在12个月内无需承担治疗费用和潜在的发病风险。需要进一步研究以确定准确识别这些患者的因素。
