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: Sierra Leone faces criticism over Ebola shutdown

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

Sierra Leone reaches final day of Ebola lockdown

38 minutes ago

Frustrated residents complained of food shortages in some neighborhoods of Sierra Leone's capital on Sunday as the country reached the third and final day of a sweeping, unprecedented lockdown designed to ...

Sierra Leone faces criticism over Ebola shutdown

Sep 20, 2014

Sierra Leone began the second day of a 72-hour nationwide shutdown aimed at containing the spread of the deadly Ebola virus on Saturday amid criticism that the action was a poorly planned publicity stunt.

Presence of peers ups health workers' hand hygiene

Sep 19, 2014

(HealthDay)—The presence of other health care workers improves hand hygiene adherence, according to a study published in the October issue of Infection Control and Hospital Epidemiology.

Sierra Leone streets deserted as shutdown begins

Sep 19, 2014

Sierra Leone's normally chaotic capital resembled a ghost town on Friday as residents were confined to their homes for the start of a three-day lockdown aimed at halting the deadly Ebola epidemic.

User comments : 0