Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester.
Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust.
Rheumatology (Oxford). 2023 May 2;62(5):1926-1935. doi: 10.1093/rheumatology/keac463.
Clinicians concerned about long-term safety of biologics in JIA may consider tapering or stopping treatment once remission is achieved despite uncertainty in maintaining drug-free remission. This analysis aims to (i) calculate how many patients with JIA stop biologics for remission, (ii) calculate how many later re-start therapy and after how long, and (iii) identify factors associated with re-starting biologics.
Patients starting biologics between 1 January 2010 and 7 September 2021 in the UK JIA Biologics Register were included. Patients stopping biologics for physician-reported remission, those re-starting biologics and factors associated with re-starting, were identified. Multiple imputation accounted for missing data.
Of 1451 patients with median follow-up of 2.7 years (IQR 1.4, 4.0), 269 (19%) stopped biologics for remission after a median of 2.2 years (IQR 1.7, 3.0). Of those with follow-up data (N = 220), 118 (54%) later re-started therapy after a median of 4.7 months, with 84% re-starting the same biologic. Patients on any-line tocilizumab (prior to stopping) were less likely to re-start biologics (vs etanercept; odds ratio [OR] 0.3; 95% CI: 0.2, 0.7), while those with a longer disease duration prior to biologics (OR 1.1 per year increase; 95% CI: 1.0, 1.2) or prior uveitis were more likely to re-start biologics (OR 2.5; 95% CI: 1.3, 4.9).
This analysis identified factors associated with successful cessation of biologics for remission in JIA as absence of uveitis, prior treatment with tocilizumab and starting biologics earlier in the disease course. Further research is needed to guide clinical recommendations.
尽管维持药物无缓解期的不确定性很大，但关注生物制剂在幼年特发性关节炎（JIA）中长期安全性的临床医生可能会考虑在达到缓解后逐渐减少或停止治疗。本分析旨在：（i）计算有多少 JIA 患者因缓解而停止生物制剂治疗，（ii）计算有多少患者随后重新开始治疗以及需要多长时间，以及（iii）确定与重新开始生物制剂治疗相关的因素。
纳入了 2010 年 1 月 1 日至 2021 年 9 月 7 日期间在英国 JIA 生物制剂登记处开始接受生物制剂治疗的患者。确定因医生报告的缓解而停止生物制剂治疗、重新开始生物制剂治疗的患者以及与重新开始生物制剂治疗相关的因素。采用多重插补法处理缺失数据。
在中位随访 2.7 年（IQR 1.4，4.0）的 1451 名患者中，269 名（19%）在中位时间 2.2 年（IQR 1.7，3.0）后因缓解而停止生物制剂治疗。在有随访数据的患者（N=220）中，有 118 名（54%）在中位时间 4.7 个月后再次开始治疗，其中 84%再次使用相同的生物制剂。与依那西普相比，在开始任何一种托珠单抗（在停止前）治疗的患者不太可能重新开始生物制剂治疗（比值比[OR]0.3；95%CI：0.2，0.7），而在开始生物制剂治疗前疾病持续时间较长（OR 每年增加 1.1；95%CI：1.0，1.2）或有葡萄膜炎病史的患者更有可能重新开始生物制剂治疗（OR 2.5；95%CI：1.3，4.9）。
本分析确定了与 JIA 中因缓解而成功停止生物制剂治疗相关的因素，包括无葡萄膜炎、先前使用托珠单抗治疗以及在疾病早期开始生物制剂治疗。需要进一步的研究来指导临床建议。
