A follow-up study of patients with juvenile idiopathic arthritis who discontinued etanercept due to disease remission

Abstract

Objectives: Assessment of the post-etanercept (ET) disease course in patients with juvenile idiopathic arthritis (JIA) who discontinued the drug due to disease remission, using a recently developed tool that scores the disease activity.

Methods: Eleven patients (F/M 9/2, median age 9.2 years), with either a polyarthritis' (9) or an oligoarthritis' (2) disease course were followed up for 12.25-27 months after ET withdrawal. The median treatment period under ET was 36 months. The Juvenile Arthritis Disease Activity Score (JADAS) was used to grade the JIA activity at the time of ET commencement, at discontinuation and at the time of the flare.

Results: All 11 patients flared during the follow-up period. Compared to the time of ET initiation, JADAS was significantly reduced at ET discontinuation as well as at the time of the flare (26.3 to 0 and to 9.5 respectively, p<0.001). The median remission following ET discontinuation lasted 3 months. The flares were controlled with methotrexate±cyclosporine A in 10 patients and methotrexate plus anti-TNF in the remaining one.

Conclusions: All patients after ET withdrawal flared but they had a minor disease activity score compared to the time of ET initiation. Flares were mostly controlled by the administration of 1 or 2 disease modifying anti-rheumatic drugs. JADAS was found to be a useful and handy tool for assessing and following-up the JIA activity over the disease course.