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Biologic drug treatments for juvenile idiopathic arthritis are effective – new SHTAC report published

Published: 22 August 2016
Joints
JIA is an inflammation of the joints that begins in people under 16

A SHTAC systematic review and economic evaluation of the clinical-effectiveness and cost-effectiveness of biologic disease modifying anti-rheumatic drugs (DMARDs) for juvenile idiopathic arthritis (JIA) is now available from the National Institute for Health Research (NIHR) Journals Library.

Juvenile idiopathic arthritis (JIA) is an inflammation of the joints that begins in people under 16 years of age where the cause or trigger is uncertain or unknown. Symptoms include pain, stiffness and swelling of the affected joints. There are several different forms of JIA, characterised by the number of affected joints or associated features. One of the most common types is polyarticular JIA, where five or more joints are affected.

Treatment typically follows a ‘stepped’ approach that begins with a non-steroidal anti-inflammatory drug, followed by corticosteroids, and DMARDs such as methotrexate. If an adequate response is not achieved with methotrexate one of several biologic DMARDs may be offered.

We did a systematic review of the clinical effectiveness of four biologic DMARDs [etanercept (Enbrel®, Pfizer), abatacept (Orencia®, Bristol-Myers Squibb), adalimumab (Humira®, AbbVie) and tocilizumab (RoActemra®, Roche) – with or without methotrexate where indicated] for the treatment of JIA. We also produced a cost-utility decision-analytic health economic model to compare the estimated cost-effectiveness of biologic DMARDs versus methotrexate.

We found that the biologic DMARDs (given with methotrexate where permitted) are more beneficial in reducing symptoms when compared to placebo treatment in children with JIA who have had an insufficient response to previous treatment. The treatment was considered sufficiently cost-effective to be recommended by the National Institute for Health and Care Excellence (NICE) for use in the National Health Service.

Randomised comparisons of biologic DMARDs with long-term efficacy and safety follow-up are needed to establish comparative effectiveness. The report is available open access from the National Institute for Health Research (NIHR) Journals Library.

For more information on SHTAC's research into bone and joint diseases please visit our Research page.

 

 

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