Evidence map›Paper›PMID 39734203›Full record

SynthesisPediatric rheumatology online journal2024

Approaches and outcomes of adalimumab discontinuation in patients with well-controlled inflammatory arthritis: a systematic search and review.

Erin Balay-Dustrude, Jessica Fennell, Kevin Baszis, Y Ingrid Goh, Daniel B Horton, Tzielan Lee, Chloe Rotman, Anna Sutton, Marinka Twilt, Olha Halyabar and 1 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Pediatric rheumatology online journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Erin Balay-Dustrude *Seattle Children's Hospital and Research Center, Seattle, WA, USA. Erin.Balay@seattlechildrens.org.ORCID http://orcid.org/0000-0001-6235-1947
Jessica Fennell *Pediatric Rheumatology, Connecticut Children's, Department of Pediatrics, University of Connecticut, Hartford, CT, USA.
Kevin BaszisDivision of Rheumatology & Immunology, Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, Saint Louis, MO, USA.
Y Ingrid GohDivision of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.
Daniel B HortonDepartment of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Tzielan LeePediatric Rheumatology, Stanford Medicine Children's Health, Stanford University School of Medicine, Stanford, CA, USA.
Chloe RotmanMedical Library, Boston Children's Hospital, Boston, MA, USA.
Anna SuttonDepartment of Epidemiology, University of Washington, Seattle, WA, USA.
Marinka TwiltDepartment of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Olha HalyabarDivision of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
CARRA JIA Inactive Disease Workgroup

Funding

Antibiotics, Juvenile Idiopathic Arthritis, and Antirheumatic Treatment ResponseR01AR074436 · NIAMS · RUTGERS, THE STATE UNIV OF N.J. · PI HORTON, DANIEL BENJAMIN · 2019 to 2022
$2.1M
NIAMS NIH HHS R01 AR074436
6 · The paper itself

Abstract

objectiveThis systematic search and review aimed to evaluate the available literature on discontinuation of adalimumab and other tumor necrosis factor inhibitors (TNFi) for patients with well-controlled chronic inflammatory arthritides.

methodsWe conducted a publication search on adalimumab discontinuation from 2000-2023 using PubMed, CINAHL, EMBASE, and Cochrane Library. Included studies evaluated adalimumab discontinuation approaches, tapering schemes, and outcomes including successful discontinuation and recapture after flare, in patients with well-controlled disease. Studies included evaluated rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA).

resultsForty-nine studies were included. Studies evaluating adalimumab alone were limited, and many reported TNFi outcomes as a single entity. Studies on rheumatoid arthritis (RA) (32, 8 RCTs) reported flare rates from 33-87%. Flares with medication tapering were slightly lower than with abrupt stop, and successful recapture was generally high (80-100%). Studies on spondyloarthropathy (12, 4 RCTs), focused on tapering, noting lower flare rates in tapering rather than abruptly stopping, and high recapture rates (~ 90%). Studies on JIA (5) were observational and demonstrated modestly lower flare rates with tapering (17-63%) versus abrupt stopping (28-82%). There was notable variability in study design, follow-up duration, specificity for TNFi results, and controlled pediatric studies.

conclusionThe literature evaluating adalimumab and other TNFi discontinuation, flare rates, and recapture success within the inflammatory arthritis population demonstrated less flare when medications were tapered, over abrupt stop in the RA, spondyloarthropathy, and JIA populations. When medications were restarted after flare, recapture of well-controlled disease was generally high in RA and spondyloarthropathy, and generally favorable in JIA.

Indexed as

AdalimumabAntirheumatic AgentsArthritis, JuvenileArthritis, PsoriaticArthritis, RheumatoidDrug TaperingHumansSpondylitis, AnkylosingAdalimumabAntirheumatic AgentsAdalimumabJuvenile idiopathic arthritisMedication discontinuationRheumatoid arthritisSpondyloarthritis

Identifiers

PMID39734203
PMCPMC11684048

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.