title: Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis.
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 moderate strength of evidence to support that DMARDs improve JIA-associated symptoms. Limited data suggest that short-term risk of cancer is low.
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA. alex.kemper@duke.edu
authors.forename: Alex R
authors.initials: AR
authors.lastname: Kemper
authors.forename: Heather A
authors.initials: HA
authors.lastname: Van Mater
authors.forename: Remy R
authors.initials: RR
authors.lastname: Coeytaux
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D057186:Comparative Effectiveness Research; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate