Modern Rheumatology

, Volume 22, Issue 4, pp 491–497 | Cite as

Guidance on the use of adalimumab for juvenile idiopathic arthritis in Japan

  • Shumpei YokotaEmail author
  • Tomoyuki Imagawa
  • Takuji Murata
  • Minako Tomiita
  • Yasuhiko Itoh
  • Satoshi Fujikawa
  • Syuji Takei
  • Masaaki Mori
Review Article


Adalimumab is a monoclonal antibody produced by DNA recombination technology, and is the first human monoclonal antibody against human tumor necrosis factor (TNF)-α in the world. Adalimumab binds with high affinity and specificity to soluble TNF-α and normalizes its biological action. The clinical development of adalimumab started in Europe. Adalimumab was approved for the treatment of rheumatoid arthritis (RA) in December 2002 in the United States and in September 2003 in the European Union. Since then, adalimumab has been approved for the expanded indications of psoriatic arthritis (PsA), ankylosing spondylitis (AS), Crohn’s disease (CD), psoriasis (Ps), and juvenile idiopathic arthritis (JIA) in the United States and the European Union, and it is now used widely for the treatment of these diseases. In Japan, adalimumab was approved for the treatment of RA in April 2008, and its use was approved for the indications of Ps and PsA in January 2010, and for CD and AS in October 2010. In Japan, children who have been diagnosed and treated according to the “Proposal for juvenile idiopathic arthritis guidance on diagnosis and treatment for primary care pediatricians and nonpediatric rheumatologists (2007)” (published in this journal in 2007; see reference 1 in the main text), but who have responded poorly to treatment must move onto the next stage of treatment. Such treatments include biological drugs, which, however, should be used with strict adherence to the indications and exclusion criteria and should be used, for the time being, only by physicians trained in how to use them. In Japan, adalimumab was approved for the treatment of JIA in July 2011. Although this drug has brought about a revolutionary advance in the treatment of JIA, it is our task to maximize its therapeutic effects and minimize its toxic effects. The guidance presented here define the indications, exclusion criteria, usage, and evaluation criteria of adalimumab for the treatment of polyarticular JIA.


Juvenile idiopathic arthritis Anti-TNF-α monoclonal antibody (adalimumab) Methotrexate Steroids 



The Pediatric Standing Committee of the Japan College of Rheumatology, in collaboration with the Pediatric Rheumatology Association of Japan, produced these guidance on the use of adalimumab for polyarticular juvenile idiopathic arthritis in Japan. The Japanese version of this work was published as a report from the Subcommittee for Juvenile Idiopathic Arthritis of the Japan Pediatric Society.

Conflict of interest



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Copyright information

© Japan College of Rheumatology 2012

Authors and Affiliations

  • Shumpei Yokota
    • 1
    Email author
  • Tomoyuki Imagawa
    • 1
  • Takuji Murata
    • 2
  • Minako Tomiita
    • 3
  • Yasuhiko Itoh
    • 4
  • Satoshi Fujikawa
    • 5
  • Syuji Takei
    • 6
  • Masaaki Mori
    • 7
  1. 1.Department of PediatricsYokohama City UniversityYokohamaJapan
  2. 2.Department of PediatricsOsaka Medical CollegeOsakaJapan
  3. 3.Department of PediatricsGraduate School of Medicine, Chiba UniversityChibaJapan
  4. 4.Department of PediatricsNippon Medical SchoolTokyoJapan
  5. 5.Institute of RheumatologyTokyo Women’s Medical UniversityTokyoJapan
  6. 6.School of Health Sciences, Faculty of Medicine, Kagoshima UniversityKagoshimaJapan
  7. 7.Department of PediatricsYokohama City University Medical CenterYokohamaJapan

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