New systemic JIA recommendations highlight thin evidence base for use of new biologics
FROM ARTHRITIS & RHEUMATISM
Rilonacept, also an IL-1 blocker, was considered by the panel to be inappropriate and at level D for evidence as initial therapy, regardless of the MD global and AJC. "Use of rilonacept was uncertain for continued disease activity after a trial of other therapeutic options irrespective of the AJC and MD global," the authors wrote.
Tocilizumab, which targets interleukin-6 (IL-6) receptors and was FDA-approved for use in systemic JIA in 2011, was generally found to be uncertain or inappropriate, and typically recommended at level D, although it was given a level A rating for use in patients with continued disease activity following GC monotherapy and a level B rating following MTX or leflunomide, or anakinra regardless of the MD global and AJC ratings. It was also recommended at the C level in patients with an MD global rating of 5 or greater, regardless of the AJC rating, despite prior NSAID monotherapy.
Although annual screening of children with systemic JIA who had an initial negative TB test prior to starting a biologic agent was rated at level D, the updated recommendations are to repeat TB screenings if a patient’s TB risk becomes moderate or high, "as determined by regional infectious disease guidelines." However, this recommendation was also only given a level D rating.
For treating MAS in JIA, the authors stated their belief in the current recommendation to use anakinra, calcineurin inhibitors, and GCs, but wrote that they anticipated more treatment data would soon provide "a better understanding of the disease process, [and so] these recommendations may be modified."
The authors also made reference to the recently published Childhood Arthritis and Rheumatology Research Alliance (CARRA) systemic JIA care treatment plans (CTPs), which are based on group consensus techniques, although not according to phenotype, but instead more focused on medications. "It is anticipated that data from comparative effectiveness research based upon the CARRA CTPs will likely be very informative in future guidelines projects."
Dr. Ringold reports that she was supported by the Agency for Healthcare Research and Quality. Dr. Weiss was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
