Discontinuation of systemic medications in Juvenile Idiopathic Arthritis - Risks and Remission: A Systematic Review and Meta-Analysis
Authors' conclusion
Medication discontinuation in JIA carried significant flare risk across both cumulative proportion and person-year rates. The observed heterogeneity primarily mirrored the clinical variation in withdrawal strategies. Differences in flare proportions may reflect residual drug exposure rather than the true strategy effects. The high recapture rate provides reassurance for advancing medication discontinuation approaches.
Study context
- Population
- JIA patients (≤18 years) in remission in studies evaluating medication withdrawal-stopping versus tapering strategiespatients in 18 studies
- Participants
- 1,905 patients
- Comparison
- Medication withdrawal-stopping versus tapering strategies
- Outcome
- Flare (pooled proportion)
Methodological detailsRandom-effects metaanalysis, subgroup analyses, meta-regression, RoB 2 and ROBINS-I assessments
- Random-effects metaanalysis
- Subgroup analyses
- Meta-regression
- RoB 2 and ROBINS-I assessments
Pooled result
As reported in the abstract
- Pooled flare estimate
- 45% (95%CI:33%-56%;I²=97%)
- Flare proportions range
- 13%-78%
Further pooled results
Moderator of flare risk: tapering strategy (meta-regression)
- β
- 0.26
- p
- P = 0.02
- Heterogeneity explained
- 19%
- The only significant moderator
Timing of flares
- Most flares occurred within 6-12 months
Flare proportions by disease subtype, medication class, and remission duration
- Flare proportions varied
Recapture of remission
- Recapture of remission
- 50%-100%
Incidence rate sensitivity analyses
- Flare incidence rate
- 0.35 flares/person-year
- Consistent findings
Original publication
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