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Subclinical markers predict relapse in juvenile idiopathic arthritis post methotrexate withdrawal
Date:6/11/2009

atients with relapses occurring within 6 months, compared to 12 months. (955270 ng/ml; p< 0.001).

Professor Dirk Foell of the University of Muenster, Germany, who conducted the study, said: "Methotrexate is effective in children with JIA and can induce a status of inactive disease. This is the first controlled trial analyzing the necessary time of treatment continuation once remission is achieved in a rheumatic disease. Our study shows that patients with elevated levels of MRP 8/14 may specifically benefit from prolonged treatment and also that a longer duration of MTX therapy after achieving remission does not influence the risk of relapse on patients with JIA. The results of our research help to make the case for the tracking of levels of biomarkers as predictors of treatment responses in this unique patient population."

In the PRINTO** study, 364 JIA patients with inactive disease for at least 3 months were randomised to receive additional MTX for either 6 or 12 months. Serum sample analysis using ELISA (Enzyme-Linked Immunosorbent Assay) was conducted in 188 patients to track MRP8/14 levels at 3 month baseline, and again at either 6 or 12 months according to study protocol. Patients were followed-up for at least 12 months after MTX discontinuation.

A log-rank analysis confirmed the differences in relapse rates between patients with MRP8/14 levels of 900ng/ml or above, compared to those with lower levels (p< 0.001). ROC (Receiver operating characteristics) analysis revealed a sensitivity of 50% and a specificity of 78% for predicting relapses at this cut-off (likelihood ratio for relapse 2.3), while the specificity was increased to 90% at a cut-off at 1400ng/ml (likelihood ratio 3.4).

At baseline, demographic and clinical characteristics were well balanced and all patients had inactive disease status. 59 (31%) had the JIA subtype of persistent oligoarthritis, 27 (14%) extended oligoarthritis, 64 (34%) polyarthritis RF-negative, 10 (5%) polyart
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Contact: Rory Berrie
eularpressoffice@uk.cohnwolfe.com
44-078-943-86425
European League Against Rheumatism
Source:Eurekalert

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