Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis

A systematic evidence review of 156 reports identified in MEDLINE？, EMBASE？, and by hand searches. There is some evidence that methotrexate is superior to conventional therapy. Among children who have responded to a biologic DMARD, randomized discontinuation trials suggest that continued treatment decreases the risk of having a flare. However, these studies evaluated DMARDs with different mechanisms of action (abatacept, adalimumab, anakinra, etanercept, intravenous immunoglobulin, tocilizumab) and used varying comparators and follow-up periods. Rates of serious adverse events are similar between DMARDs and placebo in published trials. This review identified 11 incident cases of cancer among several thousand children treated with one or more DMARD.Few data are available to evaluate the comparative effectiveness of either specific DMARDs or general classes of DMARDs. However, based on the overall number, quality, and consistency of studies, there is moderate strength of evidence to support that DMARDs improve JIA-associated symptoms. Limited data suggest that short-term risk of cancer is low.Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (systemic or intra-articular) are only partially effective in treating the symptoms of juvenile idiopathic arthritis (JIA) and its long-term complications. Treatment with disease-modifying antirheumatic drugs (DMARDs) are increasingly used because they appear to lead to better disease control. DMARDs, which interfere directly with immune cells or their function to reduce inflammation, are typically classified as either biologic (i.e., created by biologic processes) or non-biologic drugs, also referred to as synthetic DMARDs. Table 1 lists the commonly used DMARDs, their mechanism of action, and whether they have been approved for use in children by the U.S. Food and Drug Administration (FDA). Methotrexate is often considered a component of conventional treatment, along with NSAIDs and corticosteroids.To inform cli