Teh Kai Liang, Das Lena, Book Yun Xin, Hoh Sook Fun, Gao Xiaocong, Arkachaisri Thaschawee
Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower, Level 3, Zone B, Singapore, 229899, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Clin Rheumatol. 2024 May;43(5):1723-1733. doi: 10.1007/s10067-024-06928-1. Epub 2024 Mar 5.
To compare outcomes of a short and long weaning strategy of anti-tumor necrosis factor (aTNF) in our prospective juvenile idiopathic arthritis (JIA) cohort.
JIA patients on subcutaneous adalimumab with at least 6 months of follow-up were recruited (May 2010-Jan 2022). Once clinical remission on medication (CRM) was achieved, adalimumab was weaned according to two protocols-short (every 4-weekly for 6 months and stopped) and long (extending dosing interval by 2 weeks for three cycles until 12-weekly intervals and thereafter stopped) protocols. Outcomes assessed were flare rates, time to flare, and predictors.
Of 110 JIA patients, 77 (83% male, 78% Chinese; 82% enthesitis-related arthritis) underwent aTNF weaning with 53% on short and 47% on long weaning protocol. The total flare rate during and after stopping aTNF was not different between the two groups. The time to flare after stopping aTNF was not different (p = 0.639). Positive anti-nuclear antibody increased flare risk during weaning in long weaning group (OR 7.0, 95%CI: 1.2-40.8). Positive HLA-B27 (OR 6.5, 95%CI: 1.1-30.4) increased flare risks after stopping aTNF.
Duration of weaning aTNF may not minimize flare rate or delay time to flare after stopping treatment in JIA patients. Recapture rates for inactive disease at 6 months remained high for patients who flared after weaning or discontinuing medication.
在我们前瞻性的青少年特发性关节炎（JIA）队列中比较抗肿瘤坏死因子（aTNF）短期和长期撤药策略的结果。
招募接受皮下注射阿达木单抗且随访至少6个月的JIA患者（2010年5月至2022年1月）。一旦实现药物临床缓解（CRM），根据两种方案撤减阿达木单抗——短期方案（每4周一次，持续6个月后停药）和长期方案（将给药间隔延长2周，共三个周期，直至间隔为12周，此后停药）。评估的结果包括复发率、复发时间和预测因素。
110例JIA患者中，77例（83%为男性，78%为中国人；82%为附着点炎相关关节炎）接受了aTNF撤药，其中53%采用短期撤药方案，47%采用长期撤药方案。两组在停止aTNF期间及之后的总复发率无差异。停止aTNF后的复发时间无差异（p = 0.639）。在长期撤药组中，抗核抗体阳性增加了撤药期间的复发风险（OR 7.0，95%CI：1.2 - 40.8）。HLA - B27阳性（OR 6.5，95%CI：1.1 - 30.4）增加了停止aTNF后的复发风险。
在JIA患者中，撤减aTNF的持续时间可能无法使复发率降至最低或延迟停药后的复发时间。撤药或停药后复发的患者在6个月时非活动疾病的恢复率仍然很高。
