%0 Journal Article
%T Efficacy and safety of tumor necrosis factor inhibitors for systemic juvenile idiopathic arthritis: a systematic review.
%A Ishikawa T
%A Nishimura K
%A Okamoto N
%A Akamine K
%A Inoue N
%A Irabu H
%A Kato K
%A Keino H
%A Kojima M
%A Kubo H
%A Maruyama K
%A Mizuta M
%A Shabana K
%A Shimizu M
%A Sugita Y
%A Takakuwa Y
%A Takanashi S
%A Takase H
%A Umebayashi H
%A Umezawa N
%A Yamanishi S
%A Yamazaki K
%A Yashiro M
%A Yasumi T
%A Mori M
%J Mod Rheumatol
%V 0
%N 0
%D 2024 May 25
%M 38795057
%F 2.862
%R 10.1093/mr/roae050
%X <B>OBJECTIVE: </B>This systematic review assessed the efficacy and safety of tumor necrosis factor (TNF) inhibitors in patients with systemic juvenile idiopathic arthritis (JIA).<BR><B>METHODS: </B>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 for development clinical practice guidelines by Minds, a project promoting evidence-based medicine in Japan, for observational studies.<BR><B>RESULTS: </B>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%.<BR><B>CONCLUSIONS: </B>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, particularly well-designed RCTs, are necessary to confirm the efficacy and safety of TNF inhibitors for systemic JIA.