Predictors of relapse after withdrawing biotherapies in children with inactive juvenile idiopathic arthritis: a retrospective cohort study of the JIR cohort

In patients with juvenile idiopathic arthritis (JIA), the approach to discontinuing biological treatments after a period of remission remains exploratory. We aimed to identify one or more predictors of relapse after the discontinuation of biologic/targeted synthetic disease-modifying anti-rheumatic drugs. We reviewed JIA patients followed in two French tertiary centers and included in the JIR cohort who had discontinued their biologic treatments from 2000 to 2023. Remission was defined according to the Wallace criteria. The primary outcome was relapse within 1 year after treatment withdrawal. Multivariate regression was used to analyze predictors of relapse. A total of 697 JIA patients received treatment in the two centers during the study period. We analyzed 130 instances of treatment discontinuation in 115 patients (16.5%) (70.8% girls [92/130], median age 5.29 years at diagnosis [interquartile range 2.3–10.4]). Patients discontinued biological treatments after a median of 2.58 years, and 56.2% (73/130) of patients experienced relapse within 1 year after treatment withdrawal. The psoriasis subgroup had the highest relapse rate (89.5% [17/19]) and the systemic subgroup the lowest (33.3% [7/21]). The probably of relapse was increased with antinuclear antibody positivity at diagnosis (p < 0.05) and reduced with longer duration of clinically inactive disease before treatment withdrawal. Relapses are common after discontinuing biologic therapies in JIA, particularly in patients with antinuclear antibody positivity and psoriatic arthritis and those who stop treatment shortly after reaching inactive disease status. What is already known on this topic – Once remission on treatment has been achieved, criteria for withdrawing b/ts-DMARDs in JIA patients remain unclear. After cessation, more than half of patients will relapse, and few studies have succeeded in identifying factors predictive of relapse, which would be essential for patient follow-up. What this study adds –This study enabled us to identify risk factors for relapse, some of which were already suspected but others newly identified, such as anti-nuclear antibody levels and the duration of biotherapy treatment after remission. How this study might affect research, practice or policy –This is an important study which could be used to better target recommendations concerning the choice and discontinuation of biotherapies in juvenile arthritis.