Paediatric Rheumatology
Uveitis as predictor of disease flare after the first anti-TNF withdrawal in oligoarticular and polyarticular juvenile idiopathic arthritis: a multicentric Italian experience
I. Maccora1, V. Accardo2, M. Cattalini3, I. Pagnini4, A. Taddio5, E. Marrani6, F. La Torre7, M.V. Mastrolia8, I. Bellicini9, S. Pastore10, G. Simonini11
- Rheumatology Unit, ERN ReConnet Center, Meyer Children’s Hospital IRCCS, Florence, and NeuroFARBA Department, University of Florence, Italy. ilaria.maccora@unifi.it
- School of Health Human Science, University of Florence, Italy.
- Paediatric Clinic, ASST Spedali Civili di Brescia and University of Brescia, Italy.
- Rheumatology Unit, ERN ReConnet Center, Meyer Children’s Hospital IRCCS, Florence, Italy.
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, and University of Trieste, Italy.
- Rheumatology Unit, ERN ReConnet Center, Meyer Children’s Hospital IRCCS, Florence, Italy.
- Department of Paediatrics, Paediatric Rheumatology Center, Giovanni XXIII Paediatric Hospital, University of Bari, Italy.
- Rheumatology Unit, ERN ReConnet Center, Meyer Children’s Hospital IRCCS, Florence, and NeuroFARBA Department, University of Florence, Italy.
- Paediatric Clinic, ASST Spedali Civili di Brescia and University of Brescia, Italy.
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, and University of Trieste, Italy.
- Rheumatology Unit, ERN ReConnet Center, Meyer Children’s Hospital IRCCS, Florence, and NeuroFARBA Department, University of Florence, Italy.
CER17075
2024 Vol.42, N°9
PI 1867, PF 1875
Paediatric Rheumatology
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PMID: 38976296 [PubMed]
Received: 20/08/2023
Accepted : 11/01/2024
In Press: 04/07/2024
Published: 23/09/2024
Abstract
OBJECTIVES:
TNF inhibitors (TNFi) have dramatically changed the prognosis of juvenile idiopathic arthritis (JIA), but it is not clear how and when to stop therapy. We aim to describe a multicentric cohort of JIA treated with adalimumab or etanercept who discontinued the treatment for persistent inactivity and to identify factors associated with relapse.
METHODS:
In a multicentric Italian retrospective cohort study, medical records of patients with oligoarticular and polyarticular JIA were evaluated if they stopped therapy for persistent inactivity after the first TNFi.
RESULTS:
136 patients were enrolled (102 female, median age at onset 3 years (range 1–15), of whom 55.9% had oligoarticular JIA, 40.4% uveitis and 72.8% ANA positivity. Adalimumab (59.3%) and etanercept (40.7%) were started at a median age of 6 years (range 1–16), TNFi were discontinued after a median time of 30 months (range 6–90), increasing the interval (76.5%), reducing the dose (18.4%) and abrupt discontinuation (16.9%). 79.4% of patients relapsed after a median time of 5 months (range 0.5–66). Patients with uveitis relapsed earlier (log rank χ² 16.4 p<0.0001), while patients who lengthened the interval of administration showed a later relapse (log rank χ² 6.95 p=0.008). Uveitis (HR 2.11 CI 1.34–3.31), age at onset (HR 0.909 CI 0.836–0.987), duration of tapering (HR 0.938 CI 0.893–0.985) and to have a persistent oligoarticular JIA (HR 0.597 CI 0.368–0.968) are significant predictors of disease relapse (Mantel-Cox χ² 34.23 p<0.001).
CONCLUSIONS:
Younger age at onset, uveitis, duration of tapering, and non-persistent oligoarticular JIA seem to be independent risk factors for earlier relapse after the first TNFi withdrawal.
