Longer treatment for juvenile arthritis during remission does not reduce relapse rate

Apr 06, 2010

For patients with juvenile idiopathic arthritis in remission, withdrawal of treatment with the drug methotrexate over 12 months vs. 6 months did not reduce the rate of relapse, according to a study in the April 7 issue of JAMA.

New therapies have improved the remission rate in chronic inflammatory disorders such as juvenile idiopathic (JIA; persistent or recurring inflammation of the joints similar to but beginning at or before age 16). "… physicians have to balance the risk of doing too little (e.g., withdrawing medication and provoking flares [relapses]) vs. the risk of doing too much (e.g., continuing medication despite a stable remission and thereby accepting the risk of adverse effects). While evidence-based advice for starting therapies in active disease is available, no controlled data exist to suggest the need for treatment continuation after remission is achieved," the authors write.

Dirk Foell, M.D., of the University of Muenster, Germany, and colleagues analyzed whether the duration of methotrexate therapy during clinical remission of JIA influences the rate of flares after withdrawal, and also examined whether patients at risk for a flare may be identified with use of the biomarker myeloid-related protein (MRP) 8 and MRP 14 (MRP8/14), which has been shown to be a marker of subclinical disease activity not detectable by laboratory tests. The included 364 patients (median [midpoint] age, 11.0 years) with JIA recruited in 61 centers from 29 countries between February 2005 and June 2006. Patients were included at first confirmation of clinical remission while continuing medication. At the time of therapy withdrawal, levels of MRP8/14 were determined.

Patients were randomly assigned to continue with methotrexate therapy for either 6 months (group 1 [n = 183]) or 12 months (group 2 [n = 181]) after the beginning of disease remission.

Analyses indicated within 24 months after the inclusion into the study in 98 of 183 patients (56.7 percent) in group 1 and 94 of 181(55.6 percent) in group 2. The median relapse-free interval after inclusion was 21 months in group 1 and 23 months in group 2. Median follow-up duration after inclusion was 34.2 and 34.3 months in groups 1 and 2, respectively. In the 297 patients who stopped therapy while in remission, 39.6 percent in group 1 and 39.5 percent in group 2 had a flare within 1 year.

"Levels of MRP8/14 during remission were significantly higher in patients who subsequently developed flares compared with patients maintaining stable remission. Low MRP8/14 levels indicated a low risk of flares within the next 3 months following the biomarker test," the authors write.

"These data indicate a need for the stratification of patients with chronic inflammatory diseases to ensure that the intensity of treatment is adjusted to the patients' individual needs."

The researchers add that it cannot be recommended that methotrexate therapy be continued in all patients for longer than 6 months after remission is induced.

Explore further: Molecular method classifies patients with polycythemia vera

More information: JAMA. 2010;303[13]:1266-1273.

add to favorites email to friend print save as pdf

Related Stories

Drug helps brain tumor patients live longer

Jan 28, 2008

People who receive high doses of the chemotherapy drug methotrexate to treat a certain type of brain tumor appear to live longer than people receiving other treatments, according to research published in the January 29, 2008, ...

Gene mutation improves leukemia drug's effect

Jun 17, 2008

Gene mutations that make cells cancerous can sometimes also make them more sensitive to chemotherapy. A new study led by cancer researchers at Ohio State University shows that a mutation present in some cases of acute leukemia ...

Recommended for you

Guidelines presented for diagnosing focal liver lesions

11 hours ago

(HealthDay)—Focal liver lesions (FLLs) are mostly benign, and can be diagnosed based on knowledge of their presentation, associated clinical and laboratory features, and natural history, according to clinical ...

Factors tied to neck, back pain improvement identified

15 hours ago

(HealthDay)—Observational registry-based research can inform patients and physicians about prognosis for subacute or chronic neck or low back pain, according to a study published in the Aug. 1 issue of ...

User comments : 0