165 Juvenile Idiopathic Arthritis (JIA); How Do Clinicians Define Remission and Withdraw Etanercept?

Abstract

Aims: To determine how clinicians define disease remission in JIA, how long is required in remission prior to DMARD withdrawal, and what strategies are used for etanercept withdrawal.

Methods: A 10 part, piloted questionnaire was sent by email to 86 consultant members of BSPAR with one reminder.

Results: 31 clinicians (36% response rate) completed the questionnaire. To define remission, all clinicians required an active joint count of 0, 96% required no extra-articular features and 93% required no active uveitis. More than 75% rated these criteria as ‘very’ or ‘extremely’ important. ESR and CRP were less important, with only 41% rating these as ‘very’ or ‘extremely’ important as these values were deemed too non-specific. There was no agreement on other criteria. The duration of remission before withdrawing DMARD treatment varied from 6 months to 2 years with 41% responders stating 1 year and 41% 2 years. The duration required was most significantly affected by a previous failed trial off DMARDs, although only 45% rated this as ‘very’ or ‘extremely’ important. The method of etanercept withdrawal varied, half weaning to once weekly injections before stopping and 39% stopping from full dose twice weekly. 17 clinicians had withdrawn etanercept entirely. 65% of clinicians had restarted or increased etanercept in some patients.

Conclusions: Clinicians are not using the consensus remission criteria in full. Most clinicians required at least 1 year in remission before DMARD withdrawal. Several methods of etanercept withdrawal were used. 65% of clinicians had restarted or increased etanercept because of disease relapse.

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