TNFi Therapy Strategies for Juvenile Spondyloarthritis

(BACK-OFF JSpA Trial)

This trial explores different strategies for adjusting TNFi (tumor necrosis factor inhibitor) therapy in young people with juvenile spondyloarthritis, focusing on those with inactive disease. The study tests three approaches: continuing the usual treatment, increasing the time between doses, or stopping the treatment altogether. Researchers aim to determine how these changes affect the risk of flare-ups and the daily experiences of participants. The trial seeks young people aged 8 to 21 who have been diagnosed with juvenile spondyloarthritis, are currently on TNFi therapy, and have had their symptoms under control for at least six months. As an unphased trial, this study offers participants the chance to contribute to valuable research that could improve future treatment strategies.

The trial focuses on de-escalating (reducing) TNFi therapy, so you will not have to stop taking your current TNFi medication completely, but you will need to be willing to reduce it.

Research has shown that TNFi (tumor necrosis factor inhibitor) treatments are generally safe for children with juvenile spondyloarthritis. Studies have found that up to 60% of children experience no active symptoms while on these treatments, indicating good tolerance.

For those considering less frequent TNFi dosing, research has not shown an increase in side effects. Longer gaps between doses do not appear to cause more problems than the regular schedule.

However, studies on stopping TNFi treatment have shown mixed results. Some patients may experience a return of symptoms, but no major safety issues have been reported when discontinuing the treatment.

Researchers are excited about these TNFi therapy strategies for juvenile spondyloarthritis because they explore innovative dosing methods. Unlike the standard TNFi treatment, which follows a fixed schedule, one approach tests longer intervals between doses. This could mean fewer doctor visits and potentially fewer side effects while maintaining effectiveness. Another strategy investigates the possibility of stopping TNFi treatment altogether to see if patients can remain symptom-free without ongoing medication. These approaches aim to enhance convenience and personalize care for young patients.

Studies have shown that certain medications, called tumor necrosis factor inhibitors (TNFi), effectively reduce symptoms and inflammation in children with juvenile spondyloarthritis (JSpA). In this trial, participants will follow different treatment strategies. One group will continue with standard TNFi therapy, while another will have increased intervals between doses, which research suggests might control the disease without more flare-ups. A third group will stop TNFi treatment entirely, although stopping can lead to a return of symptoms in about 50% to 80% of patients. While some children manage without the medication, many experience symptoms again. Therefore, TNFi is generally effective for JSpA, but stopping it requires caution.¹²⁶⁷⁸