{Reference Type}: Journal Article
{Title}: Efficacy and safety of tumor necrosis factor inhibitors for systemic juvenile idiopathic arthritis: a systematic review.
{Author}: Ishikawa T;Nishimura K;Okamoto N;Akamine K;Inoue N;Irabu H;Kato K;Keino H;Kojima M;Kubo H;Maruyama K;Mizuta M;Shabana K;Shimizu M;Sugita Y;Takakuwa Y;Takanashi S;Takase H;Umebayashi H;Umezawa N;Yamanishi S;Yamazaki K;Yashiro M;Yasumi T;Mori M;
{Journal}: Mod Rheumatol
{Volume}: 0
{Issue}: 0
{Year}: 2024 May 25
{Factor}: 2.862
{DOI}: 10.1093/mr/roae050
{Abstract}: <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.