engleski

DISCONTINUATION OF BIOLOGIC THERAPY IN JIA PATIENTS IN CROATIA, TWO CENTRE- 8 YEAR EXPERIENCE

Introduction: The introduction of biologic agents has revolutionized the treatment of  juvenile idiopathic arthritis (JIA) due to their efficacy, speed of onset and tolerability. A numerous clinical practice guidelines and consensus statements on the criteria for biologic therapy (BT) introduction have been developed, however, the consensus on cessation of biologic agents has not been harmonized. Objectives: Presentation of our experience on discontinuation of biologic therapy in JIA patients. Methods: We conducted a retrospective two centre analysis of patients with JIA diagnosis according to ILAR criteria, treated with BT from January 2008 to May 2016. Demographic information, duration of the treatment, number of biologic agents used and discontinuation rate were extracted using medical charts. Successful discontinuation was defined as cessation of the drug due to disease control according to Wallace criteria and musculoskeletal ultrasound inactive disease. Results: Total of  92 patients (87% female, 13% male) with different  JIA subtypes, non-responders or intolerant to syntetic DMARDs, were treated with one or more biologicals. Median disease duration, from onset to the introduction of first BT, was 3.4 years (0.4-13 years). Patients were diagnosed with poli JIA in 68.5%, oligo JIA in 18.5%, ERA in 6.4%, systemic JIA in 3.3% and psoriatic JIA in 3.3%. In 88 patients first biologic drug was anti-TNF agent ( etanercept in 54 pts, adalimumab in 18 pts, infliximab in 16 pts) and 3 pts were initially treated with tocilizumab and one patient with anakinra. By the May 2016, 4 patients were lost from the follow up, 9 patients were transferred to adult rheumatology department while on BT, and 52 patient were still on BT. In 27 patients (29.3%) BT was successfully withdrawn, out of which 13 (14.1%) discontinued all medications. Majority of the patients were on the first line BT (20 pts ; 74%), and another 7 patients were on the second line BT at the time of BT cessation. In another 37 patients BT discontinuation lasted for a short period of time (2-6 months), after which BT was reintroduced due to relapse. Median duration of BT before successful discontinuation was 2.96 years (1-7.2 years). The probability of the successful withdrawal of BT was associated with a shorter disease duration at the beginning of the treatment. Conclusion: The development of optimal timeline and modality of discontinuation of BT after documentation of inactive disease is needed. In our retrospective study probability of successful withdrawal of BT was associated with shorter disease duration at the beginning of the treatment. These data correlate with current literature overview.  Future studies will hopefully identify other predictors of the successful discontinuation of biologic therapy. 

biologic therapy; juvenile idiopathic arthritis

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