Document Type
Article
Publication Date
7-22-2019
Identifier
DOI: 10.1186/s12969-019-0342-5; PMCID: PMC6647107
Abstract
BACKGROUND: We describe a Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey of North American pediatric rheumatologists that assesses physician attitudes on withdrawal of medications in systemic juvenile idiopathic arthritis (SJIA).
METHODS: A REDCap anonymous electronic survey was distributed to 100 random CARRA JIA workgroup physician-voting members. The survey had three broad sections including: A) demographic information; B) physicians' opinions on clinical inactive disease (CID) in SJIA and C) existing practices for withdrawing medications in SJIA.
RESULTS: The survey had an 86% response rate. 88 and 93% of participants agreed with the current criteria for CID and clinical remission on medications (CRM) respectively. 78% thought it necessary to meet CRM before tapering medications except steroids. 76% use CARRA SJIA consensus treatment plans always or the majority of the time. All participants weaned steroids first in SJIA patients on combination therapy, 47% waited > 6 months before tapering additional medications. 35% each tapered methotrexate over > 6 months and 2-6 months; however, 39% preferred tapering anakinra, canakinumab and tocilizumab more quickly over 2-6 months and favored spacing the dosing interval for canakinumab and tocilizumab. When patients are on combination therapy with methotrexate and biologics, 58% preferred tapering methotrexate first while others considered patient/family preference and adverse effects to guide their choice.
CONCLUSION: Most CARRA members surveyed use published consensus treatment plans for SJIA and agree with validated definitions of CID and CRM. There was agreement with tapering steroids first in SJIA. There was considerable variability with tapering decisions of all other medications.
Journal Title
Pediatr Rheumatol Online J
Volume
17
Issue
1
First Page
48
Last Page
48
MeSH Keywords
Adrenal Cortex Hormones; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Juvenile; Attitude of Health Personnel; Clinical Decision-Making; Deprescriptions; Humans; Interleukin 1 Receptor Antagonist Protein; Methotrexate; Rheumatologists; Surveys and Questionnaires
Keywords
CARRA; Inactive disease; Systemic Juvenile Idiopathic Arthritis; Withdrawal of medications
Recommended Citation
Shenoi S, Nanda K, Schulert GS, et al. Physician practices for withdrawal of medications in inactive systemic juvenile arthritis, Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey. Pediatr Rheumatol Online J. 2019;17(1):48. Published 2019 Jul 22. doi:10.1186/s12969-019-0342-5
Comments
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Publisher's Link: https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-019-0342-5