OBJECTIVE: Over the past decade, the availability of biological agents for the treatment of juvenile idiopathic arthritis (JIA) has increased substantially. Because direct head-to-head trials comparing these agents are lacking, we indirectly compared their efficacy. METHODS: In a systematic review, all available efficacy data from randomised controlled trials performed in JIA with inclusion of biological agents were retrieved. Indirect between-drug comparisons (based on Bucher's method) were conducted only if trials were comparable with regard to design and patients' characteristics related to treatment outcome. RESULTS: We identified 11 randomised controlled trials. On the basis of the equality of the trials, six trials were grouped into two networks of evidence. Network 1 included withdrawal trials which evaluated etanercept, adalimumab and abatacept in polyarticular course JIA. Indirect comparisons identified no significant differences in short-term efficacy. Network 2 indirectly compared trials with a parallel study design investigating anakinra, tocilizumab and canakinumab in systemic JIA; no differences in comparative efficacy were identified. Although the two networks were constructed on the basis of comparability, small differences in trial design and case mix still existed. CONCLUSIONS: Because of the small number of trials and the observed differences between trials, no definite conclusions could be drawn about the comparative effectiveness of the indirectly compared biological agents. Therefore, for now, the paediatric rheumatologist has to rely on observational data and safety, practical and financial arguments. Comparability of future trials needs to be improved, and head-to-head trials are required to decide on the best biological treatment for JIA.
OBJECTIVE: Over the past decade, the availability of biological agents for the treatment of juvenile idiopathic arthritis (JIA) has increased substantially. Because direct head-to-head trials comparing these agents are lacking, we indirectly compared their efficacy. METHODS: In a systematic review, all available efficacy data from randomised controlled trials performed in JIA with inclusion of biological agents were retrieved. Indirect between-drug comparisons (based on Bucher's method) were conducted only if trials were comparable with regard to design and patients' characteristics related to treatment outcome. RESULTS: We identified 11 randomised controlled trials. On the basis of the equality of the trials, six trials were grouped into two networks of evidence. Network 1 included withdrawal trials which evaluated etanercept, adalimumab and abatacept in polyarticular course JIA. Indirect comparisons identified no significant differences in short-term efficacy. Network 2 indirectly compared trials with a parallel study design investigating anakinra, tocilizumab and canakinumab in systemic JIA; no differences in comparative efficacy were identified. Although the two networks were constructed on the basis of comparability, small differences in trial design and case mix still existed. CONCLUSIONS: Because of the small number of trials and the observed differences between trials, no definite conclusions could be drawn about the comparative effectiveness of the indirectly compared biological agents. Therefore, for now, the paediatric rheumatologist has to rely on observational data and safety, practical and financial arguments. Comparability of future trials needs to be improved, and head-to-head trials are required to decide on the best biological treatment for JIA.
Authors: Simon Tarp; Gil Amarilyo; Ivan Foeldvari; Robin Christensen; Jennifer M P Woo; Neta Cohen; Tracy D Pope; Daniel E Furst Journal: Rheumatology (Oxford) Date: 2015-11-30 Impact factor: 7.580
Authors: Sarah Ringold; Pamela F Weiss; Robert A Colbert; Esi Morgan DeWitt; Tzielan Lee; Karen Onel; Sampath Prahalad; Rayfel Schneider; Susan Shenoi; Richard K Vehe; Yukiko Kimura Journal: Arthritis Care Res (Hoboken) Date: 2014-07 Impact factor: 4.794
Authors: Hilary K Michel; Robert B Noll; Nalyn Siripong; Sandra C Kim; Ellen A Lipstein Journal: J Pediatr Gastroenterol Nutr Date: 2019-03 Impact factor: 2.839
Authors: Rishi Batra; Melissa K Suh; Jeffrey S Carson; Matthew A Dale; Trevor M Meisinger; Matthew Fitzgerald; Patrick J Opperman; Jiangtao Luo; Iraklis I Pipinos; Wanfen Xiong; B Timothy Baxter Journal: Arterioscler Thromb Vasc Biol Date: 2017-12-07 Impact factor: 8.311
Authors: Daniel J Lovell; Nicolino Ruperto; Richard Mouy; Eliana Paz; Nadina Rubio-Pérez; Clovis A Silva; Carlos Abud-Mendoza; Ruben Burgos-Vargas; Valeria Gerloni; Jose A Melo-Gomes; Claudia Saad-Magalhaes; J Chavez-Corrales; Christian Huemer; Alan Kivitz; Francisco J Blanco; Ivan Foeldvari; Michael Hofer; Hans-Iko Huppertz; Chantal Job Deslandre; Kirsten Minden; Marilynn Punaro; Alan J Block; Edward H Giannini; Alberto Martini Journal: Arthritis Rheumatol Date: 2015-10 Impact factor: 10.995
Authors: Francesco La Torre; Marco Cattalini; Barbara Teruzzi; Antonella Meini; Fulvio Moramarco; Florenzo Iannone Journal: BMC Res Notes Date: 2014-05-24