Evidence map›Paper›PMID 37434157›Full record

ArticlePediatric rheumatology online journal2023

Withdrawing biologics in non-systemic JIA: what matters to pediatric rheumatologists?

Janine A van Til, Michelle M A Kip, Ellen J H Schatorjé, Gillian Currie, Marinka Twilt, Susanne M Benseler, Joost F Swart, Sebastiaan J Vastert, Nico Wulffraat, Rae S M Yeung and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric rheumatology online journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.5field-weighted citation impact, top 16% of its field
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

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
  3. 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

15 authors at 6 institutions in 2 countries.

Janine A van TilDepartment of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands.
Michelle M A KipDepartment of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands.ORCID http://orcid.org/0000-0002-6405-6789
Ellen J H SchatorjéDepartment of Paediatric Rheumatology, St. Maartenskliniek, Nijmegen, the Netherlands.
Gillian CurrieAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Marinka TwiltAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Susanne M BenselerAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Joost F SwartDepartment of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Sebastiaan J VastertDepartment of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Nico WulffraatDepartment of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Rae S M YeungDivision of Rheumatology, The Hospital for Sick Children, Department of Paediatrics, Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
C G M Karin Groothuis-OudshoornDepartment of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands.
Sanne WartaDepartment of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands.
Deborah A Marshall *Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Maarten J IJzerman *Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands. m.j.ijzerman@utwente.nl.
UCAN CAN-DU, UCAN CURE consortia
University of Calgary · CAUniversity of Twente · NLUtrecht University · NLRadboud University Nijmegen · NLUniversity Medical Center Utrecht · NLUniversity of Toronto · CA

Funding

EPA EP-D-18-001ZonMw 848006001
6 · The paper itself

Abstract

objectiveApproximately 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.

methodsA 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.

resultsThirty-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.

conclusionPatient'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.

Indexed as

Arthritis, JuvenileBiological ProductsWithholding TreatmentCanadaChildDuration of TherapyHumansNetherlandsRheumatologistsBiological ProductsBiologicalsClinical vignette studyDecision support toolJuvenile Idiopathic ArthritisTreatment withdrawal

Identifiers

PMID37434157
PMCPMC10337208
OpenAlexW4383906717

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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 OpenQuestion graph.