Research progress in drug therapy of juvenile idiopathic arthritis

Zhao, Wen-Jia; Deng, Jianghong; Li, Caifeng

doi:10.1007/s12519-022-00530-8

Cited by 4 publications

(3 citation statements)

References 159 publications

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“…Finally, another ethical issue stems from the use of biological agents in children with rheumatic diseases, especially concerning the risk of malignancies and infections including reactivation of LTBI, 67,68 which must be carefully evaluated during treatment. Further research aimed at evaluating mental capacity and psychiatric comorbidities in rheumatologic patients is advisable.…”

Section: Discussionmentioning

confidence: 99%

Informed consent and biological agents in rheumatology and internal medicine

Mandarelli

Iannone

Ferracuti

et al. 2022

Eur J Clin Investigation

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Background:The need for highly effective therapies in rheumatologic diseases has led to the widespread and growing use of a heterogeneous class of molecules called biological agents. The increasing experience with biological agents has raised concerns about safety and efficacy issues that need to be discussed in the informed consent acquisition process. Methods:The authors performed a review of the literature on biological agents focusing on their most important characteristics concerning the informed consent procedures. Results:No studies specifically addressed the issue of informed consent in patients receiving biological agents. Several studies reported data about off-label use of biological agents usually with no obvious attention to informed consent shortcomings. Conclusion:The reported association between biological agents and serious infections or malignancies, including reactivation of latent tuberculosis, needs specific disclosure in informed consent acquisition, together with information about the possible efficacy in clinical contexts often characterized by resistance to previous treatments. Ethical and clinical issues bound to the need for experimenting with new agents with potentially serious adverse effects deserve specific attention. Studies aimed at evaluating mental capacity to consent in subjects receiving biological agents are required.

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Section: Discussionmentioning

confidence: 99%

Informed consent and biological agents in rheumatology and internal medicine

Mandarelli

Iannone

Ferracuti

et al. 2022

Eur J Clin Investigation

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“…[ 1 , 2 ] Currently available therapies for sJIA include nonsteroidal anti-inflammatory drugs, glucocorticoids, synthetic disease-modifying antirheumatic drugs, and biologic synthetic disease-modifying antirheumatic drugs. [ 3 , 4 ] Improved comprehension of the biology behind sJIA has resulted in better patient outcomes through the creation of therapies that target cytokines. [ 5 ] In the case of active JIA, incorporating a biological agent into the initial treatment plan may be necessary.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of different drugs in patients with systemic juvenile idiopathic arthritis: A systematic review and network meta-analysis

Wang,

Zhang,

Zhao

et al. 2024

Medicine

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Background: The goal of this study was to estimate the relative efficacy and safety of different biological agents (infliximab, canakinumab, baricitinib, anakinra, adalimumab, tofacitinib, tocilizumab, and rilonacept) compared with placebo for systemic juvenile idiopathic arthritis (JIA) patients, through a network meta-analysis. Methods: Pubmed, Embase, and Cochrane Library were searched from database inception to July 2023 for randomized controlled trials comparing different biological agents (infliximab, canakinumab, baricitinib, anakinra, adalimumab, tofacitinib, tocilizumab, and rilonacept) or placebo directly or indirectly in JIA. Bayesian network meta-analyses were conducted. Data was extracted and analyzed by R with gemtc package. The treatment options were ranked using the surface under the cumulative ranking curve (SUCRA) value. Results: We identified 10 randomized controlled trials and analyzed 898 participants. Canakinumab (odds ratio 55.0, 95% credible intervals 2.4–67.0) was more effective than the placebo, and the difference was statistically significant. However, there was no statistical significance between other drugs versus placebo in terms of the modified ACRpedi30 (P > .05). The SUCRA shows that canakinumab ranked first (SUCRA, 86.9%), anakinra ranked second (SUCRA, 77.7%), adalimumab ranked third (SUCRA, 61.9%), and placebo ranked the last (SUCRA, 6.3%). Nevertheless, there were no notable discrepancies in the occurrence of adverse events, hepatic-related adverse events, infectious adverse event, serious adverse events, and serious infection following treatment with canakinumab, anakinra, tocilizumab, rilonacept, or the placebo. Based on the clustergram of modified ACRpedi30 and adverse events, canakinumab is suggested for JIA according to the surface under SUCRAs considering the symptom and adverse events simultaneously. Conclusions: Among patients with JIA, canakinumab exhibited the highest likelihood of being the optimal treatment for achieving the modified ACRpedi30 response rate, and neither of the tested biological agents carried a significant risk of serious adverse events.

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“…Recently tofacitinib, a JAK inhibitor, has been approved for patients with JIA. 16 Recommendations for the treatment of JIA include starting treatment with methotrexate as soon as possible and, for children with risk factors, bDMARDs could be considered as initial treatment. If disease activity is moderate or high with methotrexate (MTX), starting bDMARDs is the most acceptable step.…”

Section: Introductionmentioning

confidence: 99%

Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain

Antón,

Moreno Ruzafa,

Lopez Corbeto

et al. 2023

Journal of Health Economics and Outcomes Research

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Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

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Research progress in drug therapy of juvenile idiopathic arthritis

Cited by 4 publications

References 159 publications

Informed consent and biological agents in rheumatology and internal medicine

Informed consent and biological agents in rheumatology and internal medicine

Comparative efficacy and safety of different drugs in patients with systemic juvenile idiopathic arthritis: A systematic review and network meta-analysis

Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain

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