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Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis: a systematic review and meta-analysis of randomized trials

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Tarp, Simon ; Amarilyo, Gil ; Foeldvari, Ivan ; Christensen, Robin ; Woo, Jennifer M P ; Cohen, Neta ; Pope, Tracy D ; Furst, Daniel E. / Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis : a systematic review and meta-analysis of randomized trials. I: Rheumatology (Online). 2016 ; Bind 55, Nr. 4. s. 669-79.

Bibtex

@article{108afa4494a747aab036b326e4e77b4a,
title = "Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis: a systematic review and meta-analysis of randomized trials",
abstract = "OBJECTIVE: To define the optimal biologic agent for systemic JIA (sJIA) based on safety and efficacy data from a randomized controlled trial (RCT).METHODS: Through a systematic literature search, sJIA RCTs evaluating biologic agents were identified. The primary efficacy outcome was defined as a 30% improvement according to the modified American College of Rheumatology Paediatric 30 response criteria (JIA ACR30). The primary safety outcome was defined as serious adverse events (SAEs). Outcomes were analysed by pairwise and network meta-analyses. The quality of evidence between biologic agents was assessed by applying the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.RESULTS: From the 493 citations originally identified, 5 RCTs were eligible for inclusion-one each for anakinra, canakinumab and tocilizumab and two for rilonacept: all vs placebo. While all were effective, the network meta-analysis indicated with low-quality evidence (due to indirect comparison and inconsistency) that rilonacept-treated patients were less likely to respond than those treated with canakinumab [odds ratio (OR) 0.10 (95% CI 0.02, 0.38), P = 0.001] or tocilizumab [OR 0.12 (95% CI 0.03, 0.44), P = 0.001]. Risks of SAEs were similar among the biologic agents (supported by very low-quality evidence) and not different from placebo.CONCLUSION: Despite heterogeneous eligibility criteria and study designs across the five studies and different modified JIA ACR30 criteria, this meta-analysis of short-term RCTs presents empirical evidence that canakinumab and tocilizumab are more effective than rilonacept. Biologic agents in sJIA seem safe and comparable with respect to SAE risk in the short term.",
keywords = "Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Antirheumatic Agents, Arthritis, Juvenile, Biological Products, Humans, Interleukin 1 Receptor Antagonist Protein, Randomized Controlled Trials as Topic, Recombinant Fusion Proteins, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review",
author = "Simon Tarp and Gil Amarilyo and Ivan Foeldvari and Robin Christensen and Woo, {Jennifer M P} and Neta Cohen and Pope, {Tracy D} and Furst, {Daniel E}",
note = "{\textcopyright} The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.",
year = "2016",
month = apr,
doi = "10.1093/rheumatology/kev382",
language = "English",
volume = "55",
pages = "669--79",
journal = "Rheumatology (Online)",
issn = "1462-0332",
publisher = "Oxford University Press",
number = "4",

}

RIS

TY - JOUR

T1 - Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis

T2 - a systematic review and meta-analysis of randomized trials

AU - Tarp, Simon

AU - Amarilyo, Gil

AU - Foeldvari, Ivan

AU - Christensen, Robin

AU - Woo, Jennifer M P

AU - Cohen, Neta

AU - Pope, Tracy D

AU - Furst, Daniel E

N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PY - 2016/4

Y1 - 2016/4

N2 - OBJECTIVE: To define the optimal biologic agent for systemic JIA (sJIA) based on safety and efficacy data from a randomized controlled trial (RCT).METHODS: Through a systematic literature search, sJIA RCTs evaluating biologic agents were identified. The primary efficacy outcome was defined as a 30% improvement according to the modified American College of Rheumatology Paediatric 30 response criteria (JIA ACR30). The primary safety outcome was defined as serious adverse events (SAEs). Outcomes were analysed by pairwise and network meta-analyses. The quality of evidence between biologic agents was assessed by applying the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.RESULTS: From the 493 citations originally identified, 5 RCTs were eligible for inclusion-one each for anakinra, canakinumab and tocilizumab and two for rilonacept: all vs placebo. While all were effective, the network meta-analysis indicated with low-quality evidence (due to indirect comparison and inconsistency) that rilonacept-treated patients were less likely to respond than those treated with canakinumab [odds ratio (OR) 0.10 (95% CI 0.02, 0.38), P = 0.001] or tocilizumab [OR 0.12 (95% CI 0.03, 0.44), P = 0.001]. Risks of SAEs were similar among the biologic agents (supported by very low-quality evidence) and not different from placebo.CONCLUSION: Despite heterogeneous eligibility criteria and study designs across the five studies and different modified JIA ACR30 criteria, this meta-analysis of short-term RCTs presents empirical evidence that canakinumab and tocilizumab are more effective than rilonacept. Biologic agents in sJIA seem safe and comparable with respect to SAE risk in the short term.

AB - OBJECTIVE: To define the optimal biologic agent for systemic JIA (sJIA) based on safety and efficacy data from a randomized controlled trial (RCT).METHODS: Through a systematic literature search, sJIA RCTs evaluating biologic agents were identified. The primary efficacy outcome was defined as a 30% improvement according to the modified American College of Rheumatology Paediatric 30 response criteria (JIA ACR30). The primary safety outcome was defined as serious adverse events (SAEs). Outcomes were analysed by pairwise and network meta-analyses. The quality of evidence between biologic agents was assessed by applying the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.RESULTS: From the 493 citations originally identified, 5 RCTs were eligible for inclusion-one each for anakinra, canakinumab and tocilizumab and two for rilonacept: all vs placebo. While all were effective, the network meta-analysis indicated with low-quality evidence (due to indirect comparison and inconsistency) that rilonacept-treated patients were less likely to respond than those treated with canakinumab [odds ratio (OR) 0.10 (95% CI 0.02, 0.38), P = 0.001] or tocilizumab [OR 0.12 (95% CI 0.03, 0.44), P = 0.001]. Risks of SAEs were similar among the biologic agents (supported by very low-quality evidence) and not different from placebo.CONCLUSION: Despite heterogeneous eligibility criteria and study designs across the five studies and different modified JIA ACR30 criteria, this meta-analysis of short-term RCTs presents empirical evidence that canakinumab and tocilizumab are more effective than rilonacept. Biologic agents in sJIA seem safe and comparable with respect to SAE risk in the short term.

KW - Antibodies, Monoclonal

KW - Antibodies, Monoclonal, Humanized

KW - Antirheumatic Agents

KW - Arthritis, Juvenile

KW - Biological Products

KW - Humans

KW - Interleukin 1 Receptor Antagonist Protein

KW - Randomized Controlled Trials as Topic

KW - Recombinant Fusion Proteins

KW - Journal Article

KW - Meta-Analysis

KW - Research Support, Non-U.S. Gov't

KW - Review

U2 - 10.1093/rheumatology/kev382

DO - 10.1093/rheumatology/kev382

M3 - Journal article

C2 - 26628580

VL - 55

SP - 669

EP - 679

JO - Rheumatology (Online)

JF - Rheumatology (Online)

SN - 1462-0332

IS - 4

ER -

ID: 48268733