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Anti-tumor necrosis factor (aTNF) weaning strategy in juvenile idiopathic arthritis (JIA): does duration matter?

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Abstract

Background

To compare outcomes of a short and long weaning strategy of anti-tumor necrosis factor (aTNF) in our prospective juvenile idiopathic arthritis (JIA) cohort.

Research design and methods

JIA patients on subcutaneous adalimumab with at least 6 months of follow-up were recruited (May 2010–Jan 2022). Once clinical remission on medication (CRM) was achieved, adalimumab was weaned according to two protocols—short (every 4-weekly for 6 months and stopped) and long (extending dosing interval by 2 weeks for three cycles until 12-weekly intervals and thereafter stopped) protocols. Outcomes assessed were flare rates, time to flare, and predictors.

Results

Of 110 JIA patients, 77 (83% male, 78% Chinese; 82% enthesitis-related arthritis) underwent aTNF weaning with 53% on short and 47% on long weaning protocol. The total flare rate during and after stopping aTNF was not different between the two groups. The time to flare after stopping aTNF was not different (p = 0.639). Positive anti-nuclear antibody increased flare risk during weaning in long weaning group (OR 7.0, 95%CI: 1.2–40.8). Positive HLA-B27 (OR 6.5, 95%CI: 1.1–30.4) increased flare risks after stopping aTNF.

Conclusion

Duration of weaning aTNF may not minimize flare rate or delay time to flare after stopping treatment in JIA patients. Recapture rates for inactive disease at 6 months remained high for patients who flared after weaning or discontinuing medication.

Key Points

• It may not be necessary to taper aTNF over a long period in JIA patients as the duration of spacing out aTNF therapy after achieving CRM may not minimize the flare rate or delay time to flare.

• A positive HLA-B27 increased the flare risks after aTNF discontinuation, regardless of the weaning duration.

• Recapture rates for CID at 6 months remained high for patients who flared after weaning or discontinuing medication.

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Data availability

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical reasons.

Code availability

Not applicable.

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Acknowledgements

We thank our JIA children and families for participating in the inception cohort and registry. Their physical and mental support to the rheumatology team and JIA families in need of help throughout the past decade is much appreciated.

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Authors and Affiliations

  1. Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Children’s Tower, Level 3, Zone B, Singapore, 229899, Singapore

    Kai Liang Teh, Lena Das, Yun Xin Book & Thaschawee Arkachaisri

  2. Duke-NUS Medical School, Singapore, Singapore

    Kai Liang Teh & Thaschawee Arkachaisri

  3. Division of Nursing, KK Women’s and Children’s Hospital, Singapore, Singapore

    Sook Fun Hoh & Xiaocong Gao

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  1. Kai Liang Teh
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  6. Thaschawee Arkachaisri
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Contributions

All authors contributed to the study’s conception and design. KLT, YXB, and TA performed data collection and interpretation. TA did the data analysis. KLT and TA wrote the first draft of the manuscript, and the authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Thaschawee Arkachaisri.

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Ethics approval

The SingHealth Centralised Institutional Review Board (CIRB) approved this study and waived the need for informed consent for this database study (CIRB 2019/2961).

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An abstract of this manuscript was previously presented at the EULAR Congress in Copenhagen, in June 2022, as a poster tour presentation (POS0342).

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Teh, K.L., Das, L., Book, Y.X. et al. Anti-tumor necrosis factor (aTNF) weaning strategy in juvenile idiopathic arthritis (JIA): does duration matter?. Clin Rheumatol 43, 1723–1733 (2024). https://doi.org/10.1007/s10067-024-06928-1

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