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Discontinuation of methotrexate treatment in juvenile rheumatoid arthritis

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Pediatrics. 1997 Dec;100(6):994-7.

Discontinuation of methotrexate treatment in juvenile rheumatoid

arthritis.

Gottlieb BS, Keenan GF, Lu T, Ilowite NT.

Department of Pediatrics, Schneider Children's Hospital, Long Island

Jewish Medical Center, Long Island Campus for the Albert Einstein

College of Medicine, New Hyde Park, New York 11040, USA.

OBJECTIVE: Children with juvenile rheumatoid arthritis (JRA) treated

with methotrexate (MTX) were examined for their course after the

discontinuation of the drug to define the relapse and remission rates

and to identify predictors of relapse. METHODOLOGY: A retrospective

chart review of all patients with JRA was conducted in two pediatric

rheumatology centers. A total of 101 patients being treated with MTX

were identified. Dose, response to the drug, and length of time until

reaching a state of complete control were noted. The outcome of patients

with a complete response in whom the drug was discontinued was examined

with regards to length of time to relapse or continued remission.

RESULTS: In 25 patients, MTX was discontinued after reaching complete

control of the disease. There were no statistically significant

predictors of response to MTX identified. Of 25 whose MTX was

discontinued, relapse occurred in 13 (52%) after a mean of 11 months

after discontinuation. There was no significant difference among

patients who relapsed or those who remained in remission as to sex,

subtype of JRA, number of months to complete control, or number of

months in complete control until discontinuing MTX. Patients younger

than 41/2 years at diagnosis were found to be more likely to relapse

than patients diagnosed at a later age. In 10 of the patients who

relapsed, complete control was induced within a mean of 7 months after

restarting MTX.

CONCLUSION: The optimal time for discontinuing MTX in children with JRA

who have achieved complete control is unknown. Relapse occurred in

approximately half of the patients in whom MTX was discontinued. Because

response to reinstitution of the drug is good, it is reasonable to

discontinue MTX after prolonged complete control. It remains to be seen

whether the relapse rate can be improved by waiting for longer periods

of time in complete control before its discontinuation.

PMID: 9374571

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

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