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Value of Literature Review to Inform Development and Use of Biologics in Juvenile Idiopathic Arthritis

Klervi Golhen1, Carolyn Winskill2, Cynthia Yeh2

  • 1Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.

Frontiers in Pediatrics
|July 8, 2022
PubMed

Insights

Biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) significantly improve treatment responses in juvenile idiopathic arthritis (JIA) patients. While effective, these therapies are associated with a slightly increased risk of infections and gastrointestinal adverse events.

Area of Science:

  • Rheumatology and Immunology
  • Pediatric Inflammatory Rheumatic Diseases (PiRDs)
  • Pharmacology and Therapeutics

Background:

  • Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic disease impacting quality of life and leading to chronic morbidity.
  • Biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) have improved clinical outcomes in JIA.
  • Understanding the efficacy and safety of these advanced therapies in JIA subgroups is critical for optimizing patient care.

Approach:

  • Systematic review of published randomized controlled trials (RCTs) investigating bDMARDs or JAKi in JIA.
  • Analysis of American College of Rheumatology (ACR) pediatric (Pedi) 30, 50, and 70 responses at 3 months.
  • Comparison of treatment and control arms using risk ratios (RRs) and analysis of adverse events (AEs) and infections.

Key Points:

  • Nine RCTs reported ACR Pedi responses, with all bDMARD and JAKi treatment arms showing improved responses over controls.
  • Risk ratios for ACR Pedi 30, 50, and 70 responses ranged from 1.05-3.73, 1.20-7.90, and 1.19-8.73, respectively.
  • A slightly higher risk of gastrointestinal AEs and infections was observed in treatment arms compared to placebo or methotrexate monotherapy.

Conclusions:

  • bDMARDs and JAKi demonstrate superior treatment responses in JIA after 3 months, particularly for ACR Pedi 50 and 70.
  • The benefits of efficacious disease treatment and damage prevention must be weighed against the increased susceptibility to infections.
  • Further RCTs are needed to refine the development and utilization of biologics and JAK inhibitors in JIA management.
Abstract

Keywords:
JAK inhibitorsbDMARDsefficacyjuvenile idiopathic arthritisliterature reviewrandomized controlled trialssafetysystematic review

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