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Time spent in inactive disease prior to MTX withdrawal factors in flare risk in JIA

06 Mar 2018

In patients with juvenile idiopathic arthritis (JIA), spending at least 12 months in inactive disease before discontinuation of methotrexate therapy (MTX) appears to significantly reduce the rate of flare, a study reports.

The study included 1,514 patients who initiated MTX treatment after a mean disease duration of 2.1 years, with 40 percent having oligoarticular onset of JIA. MTX was discontinued in 982 patients (64.9 percent) due to ineffectiveness or having achieved inactive disease, among others.  

In the group of patients who discontinued MTX due to inactive disease (n=316), 184 patients (58.2 percent) had a flare on follow-up. The likelihood of a flare was found to be a function of time in inactive disease before MTX withdrawal (hazard ratio [HR], 0.95; 95 percent CI, 0.92–0.97). Patients with inactive disease for >12 months had a significantly lower flare rate (58/119; 48.7 percent; HR, 0.48; 0.34–0.69).

The most commonly occurring adverse event was MTX intolerance (eg, nausea, aversion and vomiting), accounting for 441 events (13.0 events/100 exposure years) in 307 patients (20.3 percent).

Findings of the present study show that flare risk was a function of time with clinically inactive disease before MTX discontinuation, such that the shorter the patients are in inactive disease, the higher their likelihood is for disease flare, researchers said.

To date, no guidelines and consented recommendations exist for tapering or even withdrawing medication after achieving a state of clinically inactive disease in JIA. Researchers pointed out that tapering and withdrawing of medication is complex and should be based on the needs of individual patients.

Clinicians should balance the high risk of disease flares after withdrawing treatment against the risk of AEs associated with MTX intolerance under continuing treatment, they added.

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