Disease-Modifying Antirheumatic Drugs in Children With Juvenile Idiopathic Arthritis
Results: Adding Biologic DMARDs to JIA Treatment (Methotrexate Permitted)
For each study, outcomes of symptom/disease activity, health status, inflammation (as measured by 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). Effects of treatment on radiographic evidence of progression were not reported in these studies.
In the abatacept study, 60 patients received the DMARD and 62 did not (the control group). Symptoms/disease activity improved more in the abatacept group, with the exception of scores on the parent/patient global activity (GA) assessments, which showed no statistically significant difference. Health status improved more with abatacept, but inflammation (as measured by ESR) showed no statistically significant difference.
Adalimumab was studied in 68 patients and compared with a control group of 65 patients. Symptoms and disease activity improved more in the adalimumab group. Health status and inflammation were not reported.
Anakinra was studied in 25 patients and compared with a control group of 25 patients. No statistically significant difference between groups was noted for disease activity, but health status and inflammation improved more in the anakinra group.
Infliximab was studied both with and without the addition of methotrexate (MTX). Sixty patients received treatment with MTX and 62 patients did not receive MTX. No statistically significant difference in disease activity between groups was noted. Health status and inflammation were not reported.
Tocilizumab was studied in 20 patients and compared with a control group of 23 patients. No statistical analysis was reported for disease activity, which was shown be similar in both the treatment and control groups. The tocilizumab group showed greater improvement in both health status and inflammation than did the controls.
Two studies of etanercept included 32 treated patients compared with a control group of 31 patients. In one study, MTX was not permitted in the control group. In that study, improvement in disease activity was greater in the etanercept group than in the control group, but no statistically significant difference from the control group was noted when it was allowed MTX. However, in both studies, improvement in health status and inflammation was superior in patients treated with etanercept when compared with the patients in the control group.
Intravenous immunoglobulin (IVIG) was examined in three studies. Their results were inconsistent, with no statistically significant difference between treated and control groups in either disease activity or inflammation in one study and superior improvement in disease activity with IVIG in one study. Disease activity was not reported in the third study, and ESRs were not reported in two of the three studies. Health status was not reported in any of the three studies.
Keywords: juvenile idiopathic arthritis | JIA | JRA | juvenile rheumatoid arthritis | JCA | DMARDs | disease-modifying | antirheumatic | anti-rheumatic | rheumatic | TNF-alpha blockers | biologic DMARD | nonbiologic DMARD | non-biologic DMARD | anti-inflammatory | polyarticular | pauciarticular | oligoarticular | systemic onset | etanercept | infliximab | abatacept | adalimumab | anakinra | tocilizumab | etanercept | IVIG | intravenous immunoglobulin | methotrexate | disease activity | health status | erythrocyte sedimentation rate | ESR
- 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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