Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Recent advances in biologics have greatly changed the prognosis of JIA.

Objectives To evaluate the efficacy and safety of biological agents in patients with JIA.

Methods We included all randomized controlled trials (RCTs) that compared biologics with placebo in JIA patients. According to the American College of Rheumatology Pediatric (ACR Pedi) criteria, the proportions of patients reaching 30%, 50% or 70% improvement (ACR Pedi 30/50/70) or suffering disease flare were used as the efficacy outcomes. Adverse events (AEs), infections and severe AEs were applied to evaluate the safety. The biological agents were pooled to perform comparison with placebo and among themselves, calculating odds ratios, probability of being best (P_best) and numbers needed to treat (NNT).

Results Sixteen RCTs totaling 18 reports (1689 patients) were included in the analysis focusing on 4 different types of biologics, i.e. tumor necrosis factor (TNF) inhibitors (etanercept, infliximab, adalimumab and golimumab), anti-interleukin-1 agents (anakinra, rilonacept, canakinumab), anti-interleukin-6 agent (tocilizumab) and cytotoxic lymphocyte-associated antigen-4 agent (abatacept). All biological agents were efficacious in achieving ACR Pedi 30/50/70 responses and preventing disease flare compared with placebo but with a higher risk of infections. No significant differences in efficacy were found among biologics, except that tocilizumab had a higher rate of ACR Pedi 30 response than TNF inhibitors. And for ACR Pedi 30/50/70 responses, tocilizumab was ranked the most effective option with NNT of 2 (P_best 89.9%, 82.3% and 48.4%, respectively).

Conclusions Compared to placebo, biologics are all effective in the treatment of JIA but with a higher risk of infections. Tocilizumab is more likely to achieve ACR Pedi 30/50/70 responses.

1. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. The Journal of rheumatology. 2004;31(2):390–2.

2. Ilowite NT. Update on biologics in juvenile idiopathic arthritis. Current opinion in rheumatology. 2008;20(5):613–8.

3. Otten MH, Anink J, Spronk S, van Suijlekom-Smit LW. Efficacy of biological agents in juvenile idiopathic arthritis: a systematic review using indirect comparisons. Annals of the rheumatic diseases. 2013;72(11):1806–12.

Disclosure of Interest None declared