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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Biologics for the treatment of juvenile idiopathic arthritis: a systematic review and critical analysis of the evidence

Review published: 2008.

Bibliographic details: Gartlehner G, Hansen RA, Jonas BL, Thieda P, Lohr KN.  Biologics for the treatment of juvenile idiopathic arthritis: a systematic review and critical analysis of the evidence. Clinical Rheumatology 2008; 27(1): 67-76. [PubMed: 17570009]

Quality assessment

The authors concluded that evidence was insufficient to draw firm conclusions about the balance of risks and benefits of any biologic agent for treatment of juvenile idiopathic arthritis. These conclusions were suitably cautious in reflecting the limited evidence available and appear likely to be reliable. Full critical summary

Abstract

Biologics are an important therapeutic option for treating patients with juvenile idiopathic arthritis (JIA). In adults, they are associated with rare but severe adverse events such as serious infections and malignancies. We reviewed systematically the evidence on the efficacy and safety of biologics for the treatment of JIA. We searched electronic databases up to August 2006. We limited evidence to prospective studies for efficacy but included retrospective observational evidence for safety. Outcomes of interest were clinical response, radiographic progression, quality of life, and adverse events. One randomized controlled trial (RCT) and 11 uncontrolled prospective studies provided data on efficacy; three additional studies assessed safety. The only RCT and six uncontrolled trials support the general efficacy of etanercept for the treatment of JIA. Internal and external validity of these studies are limited. The evidence on other biologic agents such as adalimumab, abatacept, anakinra, infliximab, rituximab, and tocilizumab is sparse or entirely missing. Because of the lack of sound long-term safety data, evidence is insufficient to draw firm conclusions about the balance of risks and benefits of any biologic agent for the treatment of JIA. Clinicians have to be aware of the lack of evidence supporting a long-term net benefit when considering biologics for patients with JIA.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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