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dc.contributor.authorSumner, Emma J
dc.contributor.authorAlmeida, Beverley
dc.contributor.authorPalman, Jason
dc.contributor.authorBale, Peter
dc.contributor.authorHeard, Clare
dc.contributor.authorHolzinger, Dirk
dc.contributor.authorRoth, Johannes
dc.contributor.authorFoell, Dirk
dc.contributor.authorRobinson, Emily
dc.contributor.authorUrsu, Simona
dc.contributor.authorWallace, Chris
dc.contributor.authorGilmour, Kimberly
dc.contributor.authorWedderburn, Lucy R
dc.contributor.authorRalph, Elizabeth
dc.description.abstract<jats:title>Abstract </jats:title><jats:p>The objective of this study was to determine the effectiveness of MRP8/14 as a predictor of disease flare in patients with juvenile idiopathic arthritis (JIA) following the withdrawal of methotrexate (MTX) in a routine clinical setting. All MRP8/14 tests performed at a single centre in a 27-month period were considered for analysis. Patients were assessed against criteria for inactive disease and subsequent disease flare. Decisions on whether or not to stop treatment were recorded. MRP8/14 results were assessed in conjunction with clinical information. Clinicians were also surveyed to investigate if MRP8/14 influenced their decision to discontinue MTX where this was available at that time point. One hundred four cases met the inclusion criteria during the study period. Although there was no significant difference in flares between patients with an elevated or low MRP8/14 value, in those who stopped MTX (<jats:italic>n</jats:italic> = 22), no patients with a low MRP8/14 (≤ 4000 ng/ml) result flared (follow-up time 12 months). Clinicians reported that for patients with clinically inactive disease and an elevated MRP8/14 result (&gt; 4000 ng/ml), none would advise withdrawal of MTX. Low MRP8/14 was interpreted favourably when considering stopping MTX treatment in patients with JIA. Implementation of MRP8/14 testing has changed clinical practice at this centre. However, the observation that some patients in our cohort who had an elevated MRP8/14 value did not flare after stopping MTX for non-disease-related reasons highlights the need for further biomarkers to predict the risk of flare off medication in JIA and aid clinicians in treatment decisions. <jats:table-wrap><jats:table><jats:tbody> <jats:tr> <jats:td colspan="2"><jats:bold>Key Points</jats:bold><jats:italic>• First study of serum MRP8/14 measurement in clinical practice to inform treatment decisions in patients with JIA.</jats:italic><jats:italic>• No patients with a low MRP8/14 test result went on to suffer a disease flare in 12 months of follow follow-up.</jats:italic><jats:italic>• Further biomarkers are needed to predict the risk of flare off medication in JIA and treatment decisions.</jats:italic></jats:td> </jats:tr> </jats:tbody></jats:table></jats:table-wrap></jats:p>
dc.publisherSpringer Science and Business Media LLC
dc.rightsAttribution 4.0 International
dc.titleUse of MRP8/14 in clinical practice as a predictor of outcome after methotrexate withdrawal in patients with juvenile idiopathic arthritis
dc.publisher.departmentDepartment of Medicine
prism.publicationNameClinical Rheumatology
dc.contributor.orcidWallace, Chris [0000-0001-9755-1703]
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (MR/R013926/1)
pubs.funder-project-idWellcome Trust (107881/Z/15/Z)
pubs.funder-project-idMedical Research Council (MC_UU_00002/4)
pubs.licence-display-nameApollo Repository Deposit Licence Agreement

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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International