Journal Article

POS0757 UVEITIS AS PREDICTORS OF RELAPSE AFTER ANTI-TNF TREATMENT WITHDRAWAL IN JUVENILE IDIOPATHIC ARTHRITIS: AN ITALIAN MULTICENTRIC EXPERIENCE

Pagnini, I., Simonini, G., Maccora, I., Accardo, V., Mastrolia, M. V., La Torre, F., Trevisan, M., Taddio, A., Marrani, E., Cattalini, M.

2023

Overview

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. TNF inhibitors (TNFi) have dramatically changed the prognosis of this disease, but once achieved disease remission, it is not clear how and when stop therapy.ObjectivesOur purpose is to describe a multicentric cohort of JIA patients treated with the first course of Adalimumab and Etanercept in whom therapy was discontinued to persistent remission and identify predictors of relapse.MethodsIn a multicentric Italian retrospective study (Florence, Brescia, Trieste and Bari), patients with oligoarticular and polyarticular JIA were enrolled if they stopped therapy for persistent remission after the first course of Adalimumab and Etanercept. We collected demographic, clinical and laboratory data at onset and during biologic treatment.Results136 patients were enrolled (102 female, median age at onset 3 years (R1-15)), of whom 76 (55.9%) had oligoarticular JIA and 55 (40.4%) had uveitis. ANA positivity was found in 99(72.8%) (Table 1). TNFis were started at median age of 6 years (R1-16), with a median time intercourse between TNFi initiation and diagnosis of 12 months (0-127m). Seventy-nine (59.3%) were treated with ADA, and 57 (40.7%) with ETA. Remission was achieved after a median time of 4 months (R 1-32) and TNFi was discontinued after a median time of 30 months (R 6-90). TNFi were stopped in the 76.5% increasing the interval of administration, 18.4% reducing the dose, and 16.9% abrupt discontinuation. 106 patients (79.4%) relapsed after a median time of 6 months (R 0.5-96) for arthritis in 71 (66.9%), uveitis in 19 (17.9%), both in 18 (16.9%). Patients who relapsed were more frequently female (χ² 5.9 p<0.014), had history of uveitis (χ² 7.4 p<0.006), younger at onset (median 3 vs 7, p<0.001) and when TNFi was started (6 vs 9.5, p 0.002). Moreover, the time intercourse between diagnosis and TNFi initiation was longer (13 vs 8.5 months, p 0.02) and the weaned of therapy happened in shorter time (6 vs 9 m, p 0.005) (Table 1). Patients who not-relapse suspended TNFi more frequently lengthening intervals of administration (χ² 5.2 p0.015). Relapse free survival curve after withdrawal evaluated with Kaplan-Meier showed that patients with uveitis had a significantly earlier relapse (Log Rank χ² = 12.8 p <0.0001)ConclusionAlthough this is a retrospective study, we highlighted that early age at onset and at TNFi initiation, presence of uveitis and a long time to start biologics seem to be significantly more frequent in subjects who relapse, while stop therapy lengthening the interval of drug administration might be protective.Table 1.Characteristics of JIA patients after drug withdrawal (relapse Vs no-relapse)Entire cohort(136) n (%)Not relapse(28)Relapse(108)Test and p valueFemale n, %102 (75%)16 (57.1%)86 (79.1%)χ² 5.9 p 0.014Age at diagnosis, years, m (R)3 (1-15)7 (1-15)3 (1-11)p<0.001Uveitis history, n (%)55 (40.4%)550χ² 7.4 p<0.006Type of JIApOligo n (%)eOligo n (%)Poli n (%)55 (40.4%)21 (15.4%)60 (44.1%)12313431847nsANA positivity99 (72.8%)1683χ² 4.3 p 0.03Comorbdity n291019χ²4.35 p 0.037HLA B271467χ²3.9 p 0.048Type of BiologicsADA 79ETA 57ADA 13ETA 15ADA 66ETA 42nsCharacteristics at biologic starting and withdrawalAge at B initiation years, m, R6 (1-16)9.5 (1-15)6 (1-16)p0.002Concomitant therapy111 MTX (81.6%)20(71.4%)91(84.2%)χ² 6.58 p 0.03Time between diagnosis and B (months)12 (0-127)8.5 (0-117)13 (1-127)p0.021Time free from relapse out of therapy months6 (0.5-96)16 (4-96)5 (0.5-66)p<0.001Type of flareArthritisUveitisBoth71 (66.9%)19 (17.9%)18 (16.9%)-711918nsContinuation of concomitant therapy after stop B63339χ² 0.68 p 0.43N of months to stop B6 (0-22)9 (0-22)6 (0-22)p 0.005Modality to stop BLengthening intervalsReduction of doseAbrupt104 (76.5%)25 (18.4)16 (11.8%)26(92.8%)4178 (72.2%)2115χ² 5.2 p0.02Abbreviations: n number, m median, R range, pOligo persistent oligoarthritis, eOligo: extended oligoarthritis, Poli polyarticular, B biologic, ns: non significantREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Age / Arthritis / bDMARD / Children / Diagnosis / Drug dosages / Drug withdrawal / Etanercept / Inflammatory arthritides / Medical prognosis / Monoclonal antibodies / Patients / Prognostic factors / Remission / Remission (Medicine) / Scientific Abstracts / Tumor necrosis factor / Uveitis