Using Biologic Agents in Pediatric Rheumatologic Diseases

Juvenile Idiopathic Arthritis (JIA) is an “umbrella” term which is used to cover Juvenile Rheumatoid Arthritis (JRA) and Juvenile Chronic Arthritis (JCA). Biologic agents are needed when others like NSAIDs (Non-steroidal antiinflammatory agents), DMARDs (Disease modifying antirheumatic drugs) cannot provide or maintain clinical remission, and patients are mainly bound on steroids, which are potential anti-inflammatory drugs with serious well-known side effects to the growing child. TNF-α antagonists are the first anti-cytokine agents introduced in the last decade. However, there are important subtypes, such as systemic JIA which are resistant to these drugs, because IL-1 β (Interleukin 1 β) activation is shown to be the main pathway. One of the most frequently asked questions about biologics, particularly ETN (Etanercept), is the duration of the treatment, regarding both the safety and efficacy. Regarding the current literature, ETN seems to be effective and safe in treating the children with JIA. The high dose regimen (6 mg/kg) of infliximab, a TNF monoclonal antibody, has achieved better results on JIA and is now used in pediatric rheumatology practice. Adalimumab, another TNF inhibitor and abatacept (CTLA-4) were also shown to be effective and safe in JIA. Anakinra, canakinumab, and tocilizumab are the ones recently studied, and they are shown to be effective particularly for systemic arthritis.