Predictors of flare needed following etanercept withdrawal in JIA patients
medwireNews: A substantial proportion of patients with juvenile idiopathic arthritis (JIA) who achieve clinical remission experience flares after stopping treatment with etanercept, and reliable predictors of flare are needed to help guide treatment decisions, say researchers.
Angela Aquilani (Ospedale Pediatrico Bambino Gesù, Rome, Italy) and colleagues found that of 110 patients with oligoarticular or polyarticular JIA who received the tumor necrosis factor (TNF) inhibitor for at least 18 months and discontinued treatment after achieving clinically inactive disease for at least 6 months, 60% experienced flares within 1 year of etanercept withdrawal. The median time to flare was 4.3 months.
Although these findings show that a “significant proportion” of patients experience a relapse after stopping treatment with etanercept, the researchers note that flare risk “must be balanced against the risk (in part unknown) of unnecessarily prolonging treatment with a selective cytokine inhibitor in a patient who would maintain a disease-free status even without treatment.”
They add that “no guideline exists to recommend appropriate withdrawal of TNF [inhibitors] once remission status has been achieved.”
Aquilani et al therefore investigated potential predictors of flare in their study, finding that a greater proportion of the 33 male patients experienced flares compared with the 77 female patients, at 75.8% versus 53.2%.
In a multivariate model, male sex was identified as a significant predictor of flare risk after etanercept withdrawal, along with the presence of antinuclear antibodies and elevated C-reactive protein at baseline.
Despite these factors being significantly associated with flare risk, the researchers note that the model “accounted only for 14% of the variability of the occurrence of the flare after [etanercept] discontinuation,” and that the predictors identified in their study will not “allow correct identification of patients who will flare.”
And they conclude in The Journal of Rheumatology that “large studies in a multicenter setting aimed at investigating multidimensional indicators [of flare risk] are needed, possibly including clinical variables, blood biomarkers of residual inflammation, and imaging studies.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group