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Efficacy and safety of tumor necrosis factor inhibitors for systemic juvenile idiopathic arthritis: A systematic review. | LitMetric

AI Article Synopsis

  • - This systematic review evaluated how effective and safe tumor necrosis factor (TNF) inhibitors are for treating systemic juvenile idiopathic arthritis (JIA) by examining various studies from 2000 to 2021.
  • - The review included one randomized controlled trial (RCT) and 22 observational studies, with the RCT showing that infliximab had moderate efficacy (ACR Pediatric responses of about 63.8% at 14 weeks) but also reported significant side effects like anaphylaxis in 17% of patients.
  • - The findings suggest that while TNF inhibitors appear relatively safe, they are not very effective for systemic JIA, indicating a need for more rigorous research to better evaluate their use in these

Article Abstract

Objectives: This systematic review assessed the efficacy and safety of tumor necrosis factor (TNF) inhibitors in patients with systemic juvenile idiopathic arthritis (JIA).

Methods: Studies were searched using PubMed, Embase, Cochrane, Ichushi-Web, and clinical trial registries (from 2000 to 2021). The risk of bias was assessed using the Cochrane Risk of Bias version 2 for randomized controlled trials (RCTs) and the manual of Minds for observational studies.

Results: One RCT and 22 observational studies were included. In the RCT on infliximab, the American College of Rheumatology pediatric (ACR Pedi) 30/50/70 responses at 14 weeks were 63.8%/50.0%/22.4%, with relative risks of 1.30 [95% confidence interval (CI): 0.94-1.79]/1.48 (95% CI: 0.95-2.29)/1.89 (95% CI: 0.81-4.40), respectively. In the observational studies, ACR Pedi 30/50/70 responses for etanercept at 12 months were 76.7%/64.7%/46.4%, respectively. Infliximab treatment caused anaphylaxis in 17% and an infusion reaction in 23% of patients. The incidence of macrophage activation syndrome, serious infection, and malignancy caused by TNF inhibitors was 0-4%.

Conclusions: Thus, although TNF inhibitors were relatively safe, they were unlikely to be preferentially administered in patients with systemic JIA because of their inadequate efficacy. Further studies, especially well-designed RCTs, are needed to accumulate clinical data.

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Source
http://dx.doi.org/10.1093/mr/roae050DOI Listing

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