Anna Meyer Children's Hospital and University of Florence, Florence, Italy.
University of Trieste, Trieste, Italy.
Arthritis Care Res (Hoboken). 2018 Jul;70(7):1046-1051. doi: 10.1002/acr.23435. Epub 2018 Apr 24.
To assess the time in remission after discontinuing biologic therapy in patients with juvenile idiopathic arthritis (JIA).
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's signed rank test for paired samples, chi-square tests, and Fisher's exact test were used to compare data. Pearson's and Spearman'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.
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 ± SD 18.64 ± 3.3 months versus 11.51 ± 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.
Children with oligoarticular and polyarticular JIA who stop treatment before 2 years from remission have a higher chance of relapsing after biologic withdrawal.
评估幼年特发性关节炎(JIA)患者停止生物治疗后缓解的时间。
我们纳入了在 3 个三级护理中心接受随访的 135 名患者。主要结局是评估一旦达到缓解,在停止治疗后首次复发前的缓解时间。使用 Mann-Whitney U 检验、Wilcoxon 符号秩检验(用于配对样本)、卡方检验和 Fisher 精确检验来比较数据。Pearson 和 Spearman 相关检验用于确定不同变量之间的相关系数。为了确定结局的预测因素,构建了 Cox 回归模型和 Kaplan-Meier 曲线,每个模型在进入协变量的平均值处构建。
大多数入组患者在停止生物治疗后出现了复发(135 例中的 102 例,75.6%),停止治疗后的中位缓解时间为 6 个月(范围 3-109 个月)。与其他 JIA 患者相比,全身性发病疾病患者在停止治疗后维持缓解的可能性更高(Mantel-Cox χ = 8.31,P < 0.004)。在仅分析达到缓解后 2 年以上接受生物治疗的 JIA 儿童的患者中,生物治疗持续缓解的患者停药后维持缓解的可能性更高(平均 ± SD 18.64 ± 3.3 个月与 11.51 ± 2.7 个月[P < 0.009];Mantel-Cox χ = 9.06,P < 0.002)。没有其他临床变量与持久缓解显著相关。
在达到缓解前 2 年内停止治疗的寡关节和多关节 JIA 儿童在停止生物治疗后复发的可能性更高。