Disease-Modifying Antirheumatic Drugs in Children With Juvenile Idiopathic Arthritis
Results: Combining Nonbiologic DMARDs and Conventional Anti-inflammatory Drugs
For each nonbiologic DMARD studied, the outcomes of disease activity (symptoms), health status, inflammation (measured by using the ESR), and radiographic evidence of progression were reviewed and a summary statement about the results was developed. These summaries of effects of treatment include mixed results (+/–) , statistically significant improvement over the control group (+), no statistically significant difference (NSD), and not reported (NR). The effects of treatment on radiographic evidence of progression were not reported in most studies.
In three studies of D-penicillamine, 166 treated patients and 110 in control groups were studied. Disease activity gave mixed results in the three studies. Health status improved in treated patients (when compared with the control group) in one study, results were mixed in a second study, and health status was not reported in a third study. No statistically significant difference from controls was found for ESR values. Radiographic evidence of progression was not reported.
In two studies of hydroxychloroquine that compared 82 treated patients with 74 in control groups, no statistically significant difference from controls was measured for disease activity. Health status and radiographic progression were not reported. There was no statistically significant difference in ESR between groups.
In one study of sulfasalazine that compared 35 treated patients with 34 in the control group, greater improvement in disease activity and in ESR was seen in the treated group. Health status was not reported. There was no statistically significant difference in radiographic progression between groups.
In one study of azathioprine that compared 17 treated patients with 15 in the control group, there was no statistically significant difference in disease activity and in ESR between the groups. Greater improvement in health status was seen in treated patients. Radiographic progression was not reported.
In three studies of methotrexate that compared 119 treated patients with 114 in the control groups, greater improvement in disease activity (as measured by physician global assessment of disease activity) was seen in the patients treated with methotrexate. In a third study in which symptoms were measured by active joint count, there was no statistically significant difference between the treated and control groups. Health status improved in two of the three studies. ESR values were mixed in one study, but not reported in two others. None of the three studies reported radiographic evidence of progression.
Keywords: juvenile idiopathic arthritis | JIA | DMARDs | disease-modifying | antirheumatic | anti-rheumatic | rheumatic | TNF-alpha blockers | biologic DMARD | nonbiologic DMARD | non-biologic DMARD | D-penicillamine | hydroxychloroquine | sulfasalazine | azathioprine | methotrexate | affected joint count | global activity | radiographic
- Kemper A, Coeytaux R, Sanders G, et al. Disease-Modifying Antirheumatic Drugs (DMARDs) in Children With Juvenile Idiopathic Arthritis (JIA). Comparative Effectiveness Review No. 28 (Prepared by the Duke Evidence-based Practice Center under Contract No. HHSA 290-2007-10066-I). Rockville, MD: Agency for Healthcare Research and Quality; September 2011. AHRQ Publication No. 11-EHC039-EF. Available at www.effectivehealthcare.ahrq.gov/dmardsjia.cfm.
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