Rheumatology Unit, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo 9, 1 km, 28034, Madrid, Spain.
Rheumatol Int. 2022 Jul;42(7):1133-1142. doi: 10.1007/s00296-022-05108-1. Epub 2022 Mar 19.
This study aimed to determine the flare rate (FR) in a cohort of Juvenile Idiopathic Arthritis (JIA) patients with tapered or abruptly discontinued biologic disease-modifying anti-rheumatic drugs (bDMARDs) and to identify predictors of flare. This retrospective observational study included 191 bDMARD dose-reduction events in patients with JIA followed-up at a referral hospital during the period 2000-2019. FR was analysed according to reduction strategies. To identify predictors of flare, Kaplan-Meier and Cox-regression models were plotted at 6 months (6 m), 12 months (12 m) and 24 months (24 m) following tapering (TP) or withdrawal (WD). 165 episodes of TP and 71 episodes of WD were included; 45 episodes where treatment was withdrawn after TP were included in both strategies. FR after TP was 13.4% at 6 m and increased up to 26.6% at 12 m and 51.4% at 24 m. After WD, FR was higher, 52.1% of events had a flare at 6 m and 67.6% at 12 m. Previous TP did not increase time in remission after WD of bDMARDs in the Kaplan-Meier analysis. Factors associated with flares were identified after TP at 6 m: female sex, higher number of previous bDMARDs and longer time on bDMARD treatment were positively associated with flares. Polyarticular subtype and younger age at diagnosis were associated with flares at 12 and 24 m after TP. No factors were identified in multivariable analysis after WD. TP is a successful strategy to maintain remission with lower bDMARD doses. Previous TP of bDMARDs does not seem to increase time in remission after WD.
本研究旨在确定接受生物疾病修饰抗风湿药物（bDMARD）逐渐减量或突然停药的幼年特发性关节炎（JIA）患者的 flares 发生率（FR），并确定 flares 的预测因素。这项回顾性观察研究纳入了 2000 年至 2019 年在一家转诊医院接受治疗的 JIA 患者的 191 例 bDMARD 剂量减少事件。根据减量策略分析 FR。为了确定 flares 的预测因素，在减量（TP）或停药（WD）后 6 个月（6m）、12 个月（12m）和 24 个月（24m）绘制 Kaplan-Meier 和 Cox 回归模型。纳入了 165 例 TP 和 71 例 WD ，45 例在 TP 后停药的病例同时纳入两种策略。TP 后 6m 的 FR 为 13.4%，在 12m 时增至 26.6%，在 24m 时增至 51.4%。WD 后 FR 更高，6m 时 52.1%的事件有 flares，12m 时 67.6%有 flares。Kaplan-Meier 分析显示，WD 前的 TP 并未增加 WD 后 bDMARD 缓解的时间。在 6m 时，TP 后与 flares 相关的因素包括：女性、之前使用过的 bDMARD 数量更多、bDMARD 治疗时间更长，这些因素与 flares 呈正相关。多关节型和发病时年龄较小与 TP 后 12 和 24m 的 flares 相关。WD 后多变量分析未确定任何因素。TP 是一种以较低 bDMARD 剂量维持缓解的成功策略。WD 前的 TP 似乎不会增加 WD 后缓解的时间。
