Biologics for the treatment of juvenile idiopathic arthritis: a systematic review and critical analysis of the evidence
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Biologics are an important therapeutic option for treating patients with juvenile idiopathic arthritis (JIA). In adults, they are associated with rare but severe adverse events such as serious infections and malignancies. We reviewed systematically the evidence on the efficacy and safety of biologics for the treatment of JIA. We searched electronic databases up to August 2006. We limited evidence to prospective studies for efficacy but included retrospective observational evidence for safety. Outcomes of interest were clinical response, radiographic progression, quality of life, and adverse events. One randomized controlled trial (RCT) and 11 uncontrolled prospective studies provided data on efficacy; three additional studies assessed safety. The only RCT and six uncontrolled trials support the general efficacy of etanercept for the treatment of JIA. Internal and external validity of these studies are limited. The evidence on other biologic agents such as adalimumab, abatacept, anakinra, infliximab, rituximab, and tocilizumab is sparse or entirely missing. Because of the lack of sound long-term safety data, evidence is insufficient to draw firm conclusions about the balance of risks and benefits of any biologic agent for the treatment of JIA. Clinicians have to be aware of the lack of evidence supporting a long-term net benefit when considering biologics for patients with JIA.
KeywordsBiologics Juvenile idiopathic arthritis Systematic review Targeted immune modulators
We would like to thank Timothy S. Carey, MD, MPH for helpful comments on an earlier version of this manuscript and Laura Morgan for data management.
This study was funded by a subcontract of the Oregon Health and Science University to the Cecil C. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. The funding source had no role in the collection, analysis, and interpretation of the data.
None of the authors have any competing interests with the content of this manuscript.
GG conducted data analysis and drafted the manuscript. RAH, BJL, PT, and KNL conducted data analysis and contributed to the manuscript. All authors read and approved the final manuscript.
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