High Flare Rates with Drug Withdrawal in JIA Save

While many adult rheumatologists are able to lessen or withdraw DMARD and biologic therapy in adults, little is known about the success of this practice in pediatric rheumatology clinics. Reiff and coworkers have reported on their retrospective observational study of 335 patients with polyarticular JIA or enthesitis-related arthritis and analyzed the frequence of clinically inactive disease (CID) and flare free survival (FFS) off medications. Patients were grouped by their therapies prior to withdrawal: 1) TNFi plus MTX, off MTX first, 2) TNFi plus MTX, off TNFi first, 3) MTX monotherapy, or 4) TNFi monotherapy. Sixty-four percent of all patients achieved CID. However, 89% of patients on combination therapy who withdrew TNFi first (group 2) flared within 12 months despite continuing MTX, compared to 12% of those who withdrew MTX and continued TNFi (group 1). Patients on MTX monotherapy had the best FFS after medication withdrawal and this was independent of disease subtype, labs, joint counts, corticosteroid exposure, time in CID, or method of medication discontinuation.