systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis系统回顾对青少年特发性关节炎疾病修饰治疗风湿病的药物.pdf

Kemper et al. BMC Pediatrics 2012, 12:29 /1471-2431/12/29 RESEARCH ARTICLE Open Access Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis 1,2* 1 2,3 2,4,5 2,4 Alex R Kemper , Heather A Van Mater , Remy R Coeytaux , John W Williams Jr and Gillian D Sanders Abstract Background: Treatment of juvenile idiopathic arthritis (JIA) with disease-modifying antirheumatic drugs (DMARDs) may improve outcomes compared to conventional therapy (e.g., non-steroidal anti-inflammatory drugs, intra- articular corticosteroids). The purpose of this systematic review was to evaluate the comparative effectiveness and safety of DMARDs versus conventional therapy and versus other DMARDs. Results: A systematic evidence review of 156 reports identified in MEDLINE®, EMBASE®, and by hand searches. There is some evidence that methotrexate is superior to conventional therapy. Among children who have responded to a biologic DMARD, randomized discontinuation trials suggest that continued treatment decreases the risk of having a flare. However, these studies evaluated DMARDs with different mechanisms of action (abatacept, adalimumab, anakinra, etanercept, intravenous immunoglobulin, tocilizumab) and used varying comparators and follow-up periods. Rates of serious adverse events are similar between DMARDs and placebo in published trials. This review identified 11 incident cases of cancer among several thousand children treated with one or more DMARD. Conclusions: Few data are available to evaluate the comparative effectiveness of either specific DMARDs or general classes of DMARDs. However, based on the overall number, quality, and consistency of studies, there is