Date: Sunday, November 8, 2015
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Methotrexate (MTX) is the most widely used disease modifying antirheumatic drug (DMARD) in JIA and regarded to be a safe drug, effective in around 70% of JIA cases. Therefore, strategies of withdrawing MTX therapy have become a challenging question.
Methods: Data from 1514 patients enrolled with MTX monotherapy in the national JIA biologic register BiKeR between 2005 and 2011 and prospectively observed into adulthood in the follow-up register JuMBO were considered for this analysis. Clinical characteristics, therapy, date and reasons for discontinuation of MTX were half-yearly reported by the treating physician. A recurrence of an active disease (AD) after attaining inactive disease (ID) under MTX monotherapy was defined as cJADAS-10 (Juvenile Arthritis Disease Activity Score) above five or the start of a therapy with MTX and/or a biologic DMARD. ID was defined as cJADAS-10 of lower or equal one. The time to recurrence of AD in patients withdrawing MTX due to ID was examined by a multivariable Cox-proportional hazard model.
Results: The mean age of the patients at JIA onset was 7.6 ± 4.6 years and their mean disease duration was 2.1 ± 2.8 years at inclusion in BiKeR. 27% had persistent oligoarthritis, 27% rheumatoid-factor (RF) negative polyarthritis and 68% were female. MTX was discontinued in 65% after a mean treatment duration of 2.0 ± 1.5 years during a mean follow-up of 3.5 ± 2.1 years. Reasons for MTX discontinuation were ineffectiveness including the switch to a biologic DMARD (23%), patients’ request (16%), an adverse event (10%) and ID (20%). MTX was withdrawn due to ID (n=303) after a mean treatment duration of 2.3 ± 1.0 years. Among those, 172 (56.4%) experienced AD after 11.8 ± 14.9 months. Patients who had an ID for at least 12 months before discontinuation of MTX had a significantly lower recurrence rate of AD (49.4%, HR=0.67, p=0.013) than those with ID for at least 6 months (54.2%, HR=0.85, p=0.491) compared to those with ID for less than 6 months (61%) before drug discontinuation, respectively. Patients with systemic JIA (44.4%, OR=0.33, p=0.03) and patients with psoriatic arthritis (42.3%, OR=0.31, p=0.013) had the lowest recurrence of AD compared to patients with extended oligoarthritis having the highest recurrence rate of AD (70.5%).
Conclusion: Half of the patients had recurrence of active disease after MTX withdrawal, what confirms the high flare rate in JIA. Recurrence of active disease was less common in patients who spent at least 12 months in ID before MTX discontinuation, as compared to those with shorter time in ID before drug withdrawal. Thereafter, the rate of disease recurrence seems lower in prolonged MTX therapy.
To cite this abstract in AMA style:Klotsche J, Ganser G, Foeldvari I, Huppertz H, Kuester RM, Thon A, Minden K, Horneff G. The Time Spent in Inactive Disease before MTX Withdrawal Is Relevant with Regard to the Recurrence of Active Disease in Juvenile Idiopathic Arthritis (JIA) Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-time-spent-in-inactive-disease-before-mtx-withdrawal-is-relevant-with-regard-to-the-recurrence-of-active-disease-in-juvenile-idiopathic-arthritis-jia-patients/. Accessed September 19, 2019.
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