TY - JOUR
T1 - Withdrawing biologics in non-systemic JIA
T2 - what matters to pediatric rheumatologists?
AU - van Til, Janine A.
AU - Kip, Michelle M.A.
AU - Schatorjé, Ellen J.H.
AU - Currie, Gillian
AU - Twilt, Marinka
AU - Benseler, Susanne M.
AU - Swart, Joost F.
AU - Vastert, Sebastiaan J.
AU - Wulffraat, Nico
AU - Yeung, Rae S.M.
AU - Groothuis-Oudshoorn, C. G.M.Karin
AU - Warta, Sanne
AU - Marshall, Deborah A.
AU - IJzerman, Maarten J.
AU - UCAN CAN-DU, UCAN CURE consortia
N1 - Funding Information:
JS reports grants from SOBI and consulting fee from Amgen, outside the submitted work; SV reports grants and personal fees from SOBI and Novartis during the conduct of the study; DM reports non-financial support from consultancy (Illumina) and ISPOR, and personal fees from Analytica, outside the submitted work; MIJ reports institutional support from Illumina; JvT, MK, ES, GC, MT, SB, NW, RY, CGO and SW have nothing to disclose.
Funding Information:
This work was supported by the Canadian Institutes for Health Research (Canada) [grant number 381280]; Genome Canada (Canada) [grant number OGI-150]; Genome Alberta (Canada), Ontario Genomics (Canada); The Arthritis Society (Canada) [grant number GC-18–001]; the Hospital for Sick Children (Canada); the University of Calgary (Canada); ZonMw (the Netherlands) [grant number 848006001]; and ReumaNederland (the Netherlands).
Funding Information:
We would like to thank the pediatric rheumatologists for their participation in the survey. DM was supported by the Arthur JE Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research. RSMY is supported by the Hak Ming and Deborah Chiu Chair in Paediatric Translational Research at The Hospital for Sick Children, University of Toronto.
Publisher Copyright:
© 2023, The Author(s).
Financial transaction number:
2500077735
PY - 2023/12
Y1 - 2023/12
N2 - OBJECTIVE: Approximately one third of children with JIA receive biologic therapy, but evidence on biologic therapy withdrawal is lacking. This study aims to increase our understanding of whether and when pediatric rheumatologists postpone a decision to withdraw biologic therapy in children with clinically inactive non-systemic JIA. METHODS: A survey containing questions about background characteristics, treatment patterns, minimum treatment time with biologic therapy, and 16 different patient vignettes, was distributed among 83 pediatric rheumatologists in Canada and the Netherlands. For each vignette, respondents were asked whether they would withdraw biologic therapy at their minimum treatment time, and if not, how long they would continue biologic therapy. Statistical analysis included descriptive statistics, logistic and interval regression analysis. RESULTS: Thirty-three pediatric rheumatologists completed the survey (40% response rate). Pediatric rheumatologists are most likely to postpone the decision to withdraw biologic therapy when the child and/or parents express a preference for continuation (OR 6.3; p < 0.001), in case of a flare in the current treatment period (OR 3.9; p = 0.001), and in case of uveitis in the current treatment period (OR 3.9; p < 0.001). On average, biologic therapy withdrawal is initiated 6.7 months later when the child or parent prefer to continue treatment. CONCLUSION: Patient's and parents' preferences were the strongest driver of a decision to postpone biologic therapy withdrawal in children with clinically inactive non-systemic JIA and prolongs treatment duration. These findings highlight the potential benefit of a tool to support pediatric rheumatologists, patients and parents in decision making, and can help inform its design.
AB - OBJECTIVE: Approximately one third of children with JIA receive biologic therapy, but evidence on biologic therapy withdrawal is lacking. This study aims to increase our understanding of whether and when pediatric rheumatologists postpone a decision to withdraw biologic therapy in children with clinically inactive non-systemic JIA. METHODS: A survey containing questions about background characteristics, treatment patterns, minimum treatment time with biologic therapy, and 16 different patient vignettes, was distributed among 83 pediatric rheumatologists in Canada and the Netherlands. For each vignette, respondents were asked whether they would withdraw biologic therapy at their minimum treatment time, and if not, how long they would continue biologic therapy. Statistical analysis included descriptive statistics, logistic and interval regression analysis. RESULTS: Thirty-three pediatric rheumatologists completed the survey (40% response rate). Pediatric rheumatologists are most likely to postpone the decision to withdraw biologic therapy when the child and/or parents express a preference for continuation (OR 6.3; p < 0.001), in case of a flare in the current treatment period (OR 3.9; p = 0.001), and in case of uveitis in the current treatment period (OR 3.9; p < 0.001). On average, biologic therapy withdrawal is initiated 6.7 months later when the child or parent prefer to continue treatment. CONCLUSION: Patient's and parents' preferences were the strongest driver of a decision to postpone biologic therapy withdrawal in children with clinically inactive non-systemic JIA and prolongs treatment duration. These findings highlight the potential benefit of a tool to support pediatric rheumatologists, patients and parents in decision making, and can help inform its design.
KW - Biologicals
KW - Clinical vignette study
KW - Decision support tool
KW - Juvenile Idiopathic Arthritis
KW - Treatment withdrawal
UR - http://www.scopus.com/inward/record.url?scp=85164396285&partnerID=8YFLogxK
U2 - 10.1186/s12969-023-00845-4
DO - 10.1186/s12969-023-00845-4
M3 - Article
C2 - 37434157
AN - SCOPUS:85164396285
SN - 1546-0096
VL - 21
SP - 69
JO - Pediatric rheumatology online journal
JF - Pediatric rheumatology online journal
IS - 1
M1 - 69
ER -