DISCONTINUATION OF BIOLOGICS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS AFTER ACHIEVING CLINICAL REMISSION: EXPERIENCE OF THE REPUBLIC OF CROATIA REFERRAL CENTER FOR PEDIATRIC AND ADOLESCENT RHEUMATOLOGY

Broj: 2, 2017 Rubrika: Znanstveni rad Autori: Marija Jelušić, Karla Jurić , Marijan Frković, Kristina Potočki, Nenad Vukojević, Sanja Perić, Dubravko Bajramović, Vlatko Duspara

Cilj: Utvrditi trajanje kliničke remisije tijekom terapije biološkim lijekovima te rizik od relapsa nakon prekida njihove primjene u bolesnika s juvenilnim idiopatskim artritisom (JIA). Ispitanici i metode: Retrospektivna analiza podataka bolesnika s JIA, liječenih biološkim lijekovima u Referentnom centru za pedijatrijsku i adolescentnu reumatologiju Ministarstva zdravstva RH, u razdoblju od 2010. do 2015. godine, kojima je nakon postizanja kliničke remisije ukinuta biološka terapija.
Rezultati: Biološkim lijekovima (blokatorima TNF-α, IL-1 i IL-6) liječen je 71 bolesnik s JIA. U 17 bolesnika (23,9%) biološka je terapija prekinuta zbog postizanja kliničke remisije u prosječnom trajanju od 27 mjeseci (1 – 60). Prosječno vrijeme praćenja nakon prekida biološke terapije iznosilo je 24 mjeseca (12 – 59). Rani relaps, tijekom prvih 6 mjeseci nakon prekida terapije, zabilježen je u 5/17 bolesnika (29,4%), u 1 bolesnika (5,8%) zabilježen je relaps u periodu od 6. do 12. mjeseca praćenja. Jedanaest bolesnika (64,7%) ostalo je u remisiji tijekom cijelog razdoblja praćenja.                  Zaključak: Vrijeme početka terapije biološkim lijekovima jasno je defi nirano u recentnim smjernicama za liječenje JIA. S druge strane, prekid njihove primjene nakon postizanja kliničke remisije zasad se temelji na iskustvu i prosudbi pedijatrijskih reumatologa. Stoga je razvoj primjerenih smjernica koje definiraju vrijeme i način prekida biološke terapije jedan od esencijalnih ciljeva u liječenju i praćenju bolesnika s ovom bolešću.

Aim: To determine the duration of clinical remission under biologics and the risk of relapse aft er discontinuation of their application in patients with JIA. Patients and methods: Retrospective collection of medical records of JIA patients treated with biologics at the Referral Center for Pediatric and Adolescent Rheumatology of the Republic of Croatia Ministry of Health during the period from 2010 to 2015, in whom biological therapy was discontinued after achieving clinical remission.
Results: The biologics (anti TNF, anti IL-6, anti IL-1) were used in 71 patients with JIA. In 17 patients (23.9%) the biologics were discontinued aft er achieving clinical remission after an average treatment duration of 27 months (1–60). The average monitoring time aft er the discontinuation of biologics was 24 months (12–59). Early relapses were observed in 5/17 patients (29.4%) during the first 6 months of therapy discontinuation, while in one patient (5.8%) there was a relapse in the 6- to 12-month monitoring period. Eleven patients (64.7%) remained in remission throughout the monitoring period.                                                                                                                                                                                                                                Conclusion: The introduction of biologics into the therapy is clearly defined in recent guidelines for JIA treatment. On the other hand, discontinuing their use after achieving clinical remission is still based on the experience and judgment of pediatric rheumatologists. Therefore, the development of appropriate guidelines with defined time and mode of discontinuation of biological therapy is one of the essential goals in the treatment and monitoring of JIA patients.

Broj posjeta: 12

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