Current and emerging biologics for the treatment of juvenile idiopathic arthritis

ABSTRACT

Introduction

The management of a child with juvenile idiopathic arthritis (JIA) requires a combination of pharmacological, physical, and psychosocial therapies in order to induce disease remission, by controlling articular and systemic inflammation. This review aims to provide a comprehensive discussion on the biological therapies currently in use in the treatment of JIA referring to existing recommendations and clinical evidence. We also discuss on the emerging biological drugs actually under consideration.

Areas covered

Recent findings on immunological mechanisms involved in the pathogenesis of the disease allowed us to identify several specific targets for biologic therapies. A systematic literature review was conducted between January 1997 and January 2020 on PubMed including national and international guidelines and recommendations, trials and case–control studies.

Expert opinion

There is now a plethora of therapies that are directed against variable targets, and the physician has to choose the most appropriate available medication in order to achieve early and sustained remission with as few side effects as possible. Research is advancing very fast in order to be more and more specific in suppressing inflammatory pathways without harming natural defenses. Finally, pharmacoeconomic considerations will also be very important to deal with, considering the high cost of most of these molecules.

KEYWORDS:

• Juvenile idiopathic arthritis
• pediatric rheumatology
• biologic therapy
• clinical evidence

Article highlights

• Biologic therapy, by targeting specific cytokines or cellular interactions, interferes with the activation and regulation of the immune system.

• Since these drugs have been introduced in clinical practice the prognosis for children with JIA has dramatically improved.

• Variable clinical responses have been observed to specific biological drugs among different JIA subtypes.

• Evidence for new agents are promising; these review describes recent and ongoing clinical trials on emerging biologic drugs and small molecules available.

• In clinical practice pharmacoeconomic aspects have to be considered; biosimilars are also an effective option to increase access to biologic treatment in patients with JIA worldwide.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.