When and how to stop etanercept after successful treatment of patients with juvenile idiopathic arthritis

Currently, little is known about when or how to stop etanercept in patients with juvenile idiopathic arthritis (JIA) when a good clinical response is reached, and therefore no guidelines are available. 1 We evaluated the disease course of patients with JIA who discontinued etanercept because of a sustained good clinical response. This study is embedded in the Arthritis and Biologicals in Children (ABC) project, a prospective ongoing multicentre, observational study that includes all Dutch patients with JIA who used etanercept since 1999. 23 We selected all patients who discontinued etanercept because of sustained good clinical response determined by the treating doctor. The outcome measures to assess disease activity consisted of the JIA core set of six response variables. 4 To evaluate the disease course we used the criteria for inactive disease on medication (IDM) or off medication (ID) and the criteria for clinical remission on medication (CRM) or off medication (CR) by Wallace. 56 We defined erythrocyte sedimentation rate (ESR) values under 16 mm/h as normal and stated that a doctor’s overall assessment score below 10 mm on a visual analogue scale (VAS) indicated no disease activity. 7 Differences were tested