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Pediatric Drugs

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01.12.2019 | Systematic Review

Treatment Withdrawal Following Remission in Juvenile Idiopathic Arthritis: A Systematic Review of the Literature

verfasst von: Olha Halyabar, Jay Mehta, Sarah Ringold, Dax G. Rumsey, Daniel B. Horton

Erschienen in: Pediatric Drugs | Ausgabe 6/2019

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Abstract

Background

Early diagnosis and treatment of juvenile idiopathic arthritis (JIA) with conventional and biologic disease-modifying anti-rheumatic drugs have vastly improved outcomes for children with these diseases. Currently, a large proportion of children with JIA are able to achieve clinical inactive disease and remission. With this success, important questions have arisen about when medications can be stopped and how to balance the risks and benefits of continuing medications versus the potential for flare after stopping.

Aim

The aim was to conduct a systematic review of the available literature to summarize current evidence about medication withdrawal for JIA in remission.

Methods

We conducted a systematic literature search in PubMed and Embase from 1990 to 2019. References were first screened by title and then independently screened by title and abstract by two authors. A total of 77 original papers were selected for full-text review. Data were extracted from 30 papers on JIA and JIA-associated uveitis, and the quality of the evidence was evaluated using National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) tools. Studies on biochemical and radiologic biomarkers were also reviewed and summarized.

Results

Most studies investigating treatment withdrawal in JIA have been observational and of poor or fair quality; interpretations of these studies have been limited by differences in study populations, disease and remission durations, the medications withdrawn, approaches to withdrawal, and definitions of disease outcomes. Overall the data suggest that flares are common after stopping JIA medications, particularly biologic medications. Clinical characteristics associated with increased risks of flare have not been consistently identified. Biochemical biomarkers and ultrasound findings have been shown to predict outcomes after stopping medications, but to date, no such predictor has been consistently validated across JIA populations. Studies have also not identified optimal strategies for withdrawing medication for well-controlled JIA. Promising withdrawal strategies include discontinuing methotrexate before biologic medications in children receiving combination therapy, dose reduction for children on biologics, and treat-to-target approaches to withdrawal. These and other strategies require further investigation in larger, high-quality studies.

Conclusions

The published literature on treatment withdrawal in JIA has varied in design and quality, yielding little conclusive evidence thus far on the management of JIA in remission. Given the importance of this question, international collaborative efforts are underway to study clinical and biologic predictors of successful medication withdrawal in JIA. These efforts may ultimately support the development of personalized approaches to withdrawing medication in children with JIA in remission.

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Titel: Treatment Withdrawal Following Remission in Juvenile Idiopathic Arthritis: A Systematic Review of the Literature
verfasst von: Olha Halyabar
Jay Mehta
Sarah Ringold
Dax G. Rumsey
Daniel B. Horton
Publikationsdatum: 01.12.2019
Verlag: Springer International Publishing
Erschienen in: Pediatric Drugs / Ausgabe 6/2019
Print ISSN: 1174-5878
Elektronische ISSN: 1179-2019
DOI: https://doi.org/10.1007/s40272-019-00362-6

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Springer Medizin

Treatment Withdrawal Following Remission in Juvenile Idiopathic Arthritis: A Systematic Review of the Literature

Abstract

Background

Aim

Methods

Results

Conclusions

Neu im Fachgebiet Pädiatrie

Bei Amblyopie früher abkleben als bisher empfohlen?

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

ADHS-Medikation erhöht das kardiovaskuläre Risiko

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

Update Pädiatrie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Aim

Methods

Results

Conclusions

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Weitere Artikel der Ausgabe 6/2019

A Review of Regional Anesthesia in Infants

Long-Term Outcomes and Practical Considerations in the Pharmacological Management of Tyrosinemia Type 1

Authors’ Reply to K. Langdon and Colleagues’ Comment on: “Botulinum Toxin in the Management of Children with Cerebral Palsy”

Comment on: “Botulinum Toxin in the Management of Children with Cerebral Palsy”

Pharmacological Prevention and Management of Postoperative Relapse in Pediatric Crohn’s Disease

Acknowledgement to Referees

Neu im Fachgebiet Pädiatrie

Bei Amblyopie früher abkleben als bisher empfohlen?

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

ADHS-Medikation erhöht das kardiovaskuläre Risiko

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

Update Pädiatrie