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Comparative Study
. 2012 Mar 15:12:29.
doi: 10.1186/1471-2431-12-29.

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

Alex R Kemper  1 , Heather A Van Mater, Remy R Coeytaux, John W Williams Jr, Gillian D Sanders
Affiliations
Comparative Study

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

Alex R Kemper et al. BMC Pediatr. .

Abstract

Background: Treatment of juvenile idiopathic arthritis (JIA) with disease-modifying antirheumatic drugs (DMARDs) may improve outcomes compared to conventional therapy (e.g., non-steroidal anti-inflammatory drugs, intra-articular corticosteroids). The purpose of this systematic review was to evaluate the comparative effectiveness and safety of DMARDs versus conventional therapy and versus other DMARDs.

Results: 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.

Conclusions: 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.

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Figures

Figure 1
Figure 1
Literature flow diagram. This figure describes the flow of literature for the original AHRQ-sponsored CER, which included one key question not considered in the present report. Citations were not separated out by key question until the full-text screening stage. Reasons for exclusion are available in Appendix F of Reference 1.
Figure 2
Figure 2
Treatment comparisons evaluated in the efficacy studies.
See this image and copyright information in PMC

References

    1. Kemper AR, Coeytaux R, Sanders GD, Van Mater H, Williams JW, Gray RN, 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.) Rockville, MD: Agency for Healthcare Research and Quality. http://www.ncbi.nlm.nih.gov/books/NBK65169/pdf/TOC.pdf - PubMed
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    1. Agency for Healthcare Research and Quality: Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews, Version 1.0 [Draft posted Oct. 2007] Rockville, MD: Agency for Healthcare Research and Quality; http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf

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