TOPLINE:

Relapse occurred in over half of patients with juvenile idiopathic arthritis (JIA) within a year of stopping biologic or targeted synthetic disease-modifying antirheumatic drug (DMARD) treatment after reaching an inactive disease status. Antinuclear antibody (ANA) positivity at diagnosis was associated with increased odds of relapse, whereas longer duration of inactive disease was tied to reduced odds.

METHODOLOGY:

• Researchers conducted a retrospective chart review of children with JIA who received treatment between 2000 and 2023 at two tertiary paediatric rheumatology centres in France.​
• They included 115 patients with JIA (median age at diagnosis, 5.29 years; 70.8% girls) who achieved remission according to the Wallace criteria, which was sustained for at least 6 months before withdrawal of biologic or targeted synthetic DMARD treatment. These patients accounted for 130 treatment discontinuation events.
• Data were collected at the time of diagnosis and during follow-up for various clinical and laboratory variables (including ANA status and JIA subtype), duration of remission, tapering approach, and treatment withdrawals.
• The primary outcome was relapse, defined as not fulfilling the remission criteria within 1 year after cessation of biologic or targeted synthetic DMARD treatment; the secondary outcome was the occur­rence of relapse within 3 years after treatment discontinuation.
• Multivariable logistic regression was used to identify predictors of relapse within a year of treatment withdrawal.

TAKEAWAY:

• Relapse within 1 year of biologic or targeted synthetic DMARD treatment withdrawal was observed in 56.2% of patients with JIA.
• ANA positivity at diagnosis was associated with increased odds of relapse in patients with JIA (adjusted odds ratio [aOR], 13.0; P < .001).
• Longer duration of inactive disease was associated with reduced odds of relapse (aOR, 0.57; P = .027).
• Among cases of withdrawal without relapse in the first year, five factors were associated with a higher relapse rate within 3 years: younger age at diagnosis (P = .010), ANA positivity at diagnosis (P < .001), elevated ANA titres (P = .004), variations among JIA subtypes (P < .001), and longer duration from diagnosis to the initiation of biologic or targeted synthetic DMARDs (P = .012).

IN PRACTICE:

"Our study showed that physicians use a variety of strategies to stop biotherapy. Clear protocols for b-DMARD [biologic DMARD] withdrawal in JIA are needed to enable more rigorous analyses," the authors wrote.

SOURCE:

The study was led by Vincent Jallot, Assistance Publique - Hôpitaux de Paris, Université de Paris Saclay, Le Kremlin-Bicétre, France. It was published online on November 20, 2025, in Pediatric Rheumatology.

LIMITATIONS:

The study was retrospective in nature. Some patients were included multiple times for different withdrawals. Children who were classified as having undifferentiated JIA were not included.

DISCLOSURES:

The study did not receive any specific funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.