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Tumor Necrosis Factor Inhibitors in the Management of Juvenile Idiopathic Arthritis

An Evidence-Based Review

Abstract

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder of unknown origin that is often treated with a variety of disease-modifying agents. Tumor necrosis factor (TNF) inhibitors are a group of genetically engineered biologic agents that target the proinflammatory cytokine TNF. This review focuses on the use of TNF inhibitors in JIA.

Etanercept was the first TNF inhibitor approved for use in children with moderate to severe polyarticular-course JIA following encouraging results from a randomized, double-blind, placebo-controlled, multicenter trial in children. Open-label extension studies of the original trial involving 8 years of follow-up demonstrated the long-term safety and efficacy of etanercept in children. Other studies from established registries also corroborate the safety of etanercept in JIA. The second TNF inhibitor to be approved for use in JIA is adalimumab following recent favorable results from another randomized, placebo-controlled, multicenter study in polyarticular-course JIA. While infliximab is not approved by the US FDA for use in JIA, it is frequently used in clinical practice for this indication. However, because the chimeric structure of infliximab incorporates murine components, it has the potential for allergic and infusion reactions. Patient responses to individual TNF inhibitors may vary depending on concomitant medications such as methotrexate, and also on the category of JIA.

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Acknowledgements

We would like to thank our pharmacist, Barbara Marquardt, for her help with table I. No sources of funding were used to prepare this manuscript. Carol Wallace has received grants from Amgen, Centocor and Pfizer. Susan Shenoi has no conflicts of interest to declare that are directly relevant to the content of this review.

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Correspondence to Dr Carol A. Wallace.

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Shenoi, S., Wallace, C.A. Tumor Necrosis Factor Inhibitors in the Management of Juvenile Idiopathic Arthritis. Pediatr-Drugs 12, 367–377 (2010). https://doi.org/10.2165/11532610-000000000-00000

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Keywords

  • Infliximab
  • Etanercept
  • Juvenile Idiopathic Arthritis
  • Adalimumab
  • Tumor Necrosis Factor Inhibitor