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Longer Therapy No Better Than Shorter in JIA Remission

12 months of methotrexate no better than six months' treatment in juvenile idiopathic arthritis

TUESDAY, April 6 (HealthDay News) -- Among patients with juvenile idiopathic arthritis (JIA), continuing methotrexate treatment for a year during remission does not prevent eventual disease relapse any better than continuing it for six months during remission, and higher myeloid-related proteins 8 and 14 heterocomplex (MRP8/14) concentrations are associated with risk of relapse after discontinuing the drug, according to a study in the April 7 issue of the Journal of the American Medical Association.

Dirk Foell, M.D., of the University of Muenster in Germany, and colleagues randomized 364 patients with JIA (median age, 11 years) to continue methotrexate therapy for either six months or 12 months after start of disease remission. The researchers calculated the groups' relapse rates and time to relapse, and evaluated levels of the phagocyte activation marker MRP8/14 as a prognostic factor for the risk of flares.

Relapse within 24 months occurred in 56.7 percent of patients on six-month extended treatment and 55.6 percent of patients on 12-month extended therapy, the investigators note. The median relapse-free periods were 21 and 23 months, respectively, for the two groups. The researchers found that levels of MRP8/14 during remission were higher in patients who later developed flares (median level, 715 ng/mL) compared with patients who stayed in stable remission (400 ng/mL), and low MRP8/14 levels were found to indicate a low risk of flares within three months.

"In patients with JIA in remission, a 12-month versus six-month withdrawal of methotrexate did not reduce the relapse rate. Higher MRP8/14 concentrations were associated with risk of relapse after discontinuing methotrexate," the authors write.

Wyeth Pharmaceuticals funded the patients' insurance in Germany.

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