Disease-Modifying Antirheumatic Drugs in Children With Juvenile Idiopathic Arthritis
DMARDs Included in the Comparative Effectiveness Review
The nonbiologic and biologic DMARDs that have been studied in children with JIA and were included in the CER are listed by name; the target of action for each DMARD, as currently understood, is given.
Nonbiologic DMARDs include:
Azathioprine: Target of activity is purine synthesis; inhibits T-lymphocyte proliferation.
D-Penicillamine: Target of activity is unknown.
Hydroxychloroquine: Target of activity is uncertain but likely is T-lymphocytes.
Leflunomide: Target of activity is pyridine synthesis.
Methotrexate: Target of activity is dihydrofolate reductase and folate metabolism.
Sulfasalazine: Target of activity is uncertain but likely multifactorial, including impairment of lymphocyte function and cytokine synthesis.
Biologic DMARDs include:
Adalimumab: Target of activity is TNF-α.
Etanercept: Target of activity is TNF-α.
Infliximab: Target of activity is TNF-α.
Abatacept: Target of activity is CD28.
Anakinra: Target of activity is interleukin 1 (IL-1).
Rituximab: Target of activity is CD20.
Tocilizumab: Target of activity is the IL-6 receptor.
Intravenous immunoglobulin: Target of activity is Fc receptors.
Keywords: juvenile idiopathic arthritis | JIA | JRA | juvenile rheumatic arthritis | JCA | juvenile chronic arthritis | DMARDs | disease-modifying | antirheumatic | anti-rheumatic | rheumatic | biologic | non-biologic | tumor necrosis factor-alpha | TNF-alpha | TNF-a | azathioprine | D-penicillamine | hydroxychloroquine | leflunomide | methotrexate | sulfasalazine | adalimumab | etanercept | infliximab | abatacept | anakinra | rituximab | tocilizumab | intravenous immunoglobulin | IVIG
- 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 http://www.effectivehealthcare.ahrq.gov/dmardsjia.cfm.
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