Biologics for the treatment of juvenile idiopathic arthritis: a systematic review and critical analysis of the evidence

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 biologic...

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Bibliographic Details
Published in:Clinical rheumatology 2008-01, Vol.27 (1), p.67-76
Main Authors: Gartlehner, Gerald, Hansen, Richard A., Jonas, Beth L., Thieda, Patricia, Lohr, Kathleen N.
Format: Article
Language:English
Subjects:
Antirheumatic Agents - adverse effects
Antirheumatic Agents - therapeutic use
Arthritis, Juvenile - diagnostic imaging
Arthritis, Juvenile - physiopathology
Arthritis, Juvenile - therapy
Arthrography
Biological Products - adverse effects
Biological Products - therapeutic use
Clinical trials
Databases as Topic
Disease Progression
Drug therapy
Evidence-Based Medicine
Humans
Joints - pathology
Joints - physiopathology
Medicine
Medicine & Public Health
Original Article
Quality of Life
Rheumatology
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Summary: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.
ISSN:0770-3198
1434-9949
DOI:10.1007/s10067-007-0654-6