title: Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting.
abstract: OBJECTIVE
  The aim of this study was to carry out a safety evaluation of biologic agents in patients with JIA and associated uveitis.
  
  
  METHODS
  In three tertiary centres in Finland, all adverse events (AEs) in 348 consecutive patients were collected. AEs were classified according to the Common Terminology Criteria for AEs.
  
  
  RESULTS
  A total of 1516 patient-years (py) were included: 710 on etanercept, 591 on infliximab, 188 on adalimumab, 8 on rituximab, 5 on anakinra, 6 on tocilizumab, 6 on abatacept and 1 on golimumab. The median follow-up of an individual patient was 51 months (range 1-155). The most common of the 2902 AEs (191/100 py) observed were mild infections, infusion or injection site reactions and alanine aminotransferase elevations. At least one AE occurred in 319 (92%) patients and 121 (35%) had at least one serious AE (SAE). The rate of SAEs was 11.4/100 py on etanercept, 11.8 on infliximab, 10.1 on adalimumab, 15.7 on abatacept, 31.2 on tocilizumab and 87.5 on rituximab, higher than with most anti-TNF agents (P = 0.005). No cases of malignant neoplasms or tuberculosis were detected. New-onset uveitis occurred in 9 patients, psoriasis or psoriasiform lesions in 13 and IBD in 6.
  
  
  CONCLUSIONS
  Mild and moderate AEs in patients with JIA treated with biologics were more frequent than previously reported. SAEs were observed in one-third of the patients, but SAEs seldom led to drug discontinuation.
authors.affiliation: Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland maarit.tarkiainen@helsinki.fi.
authors.forename: Maarit
authors.initials: M
authors.lastname: Tarkiainen
authors.affiliation: Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Tynjälä
authors.affiliation: Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Vähäsalo
authors.affiliation: Children's Hospital, Helsinki University Central Hospital, Institute of Clinical Medicine, University of Helsinki, Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Lahdenne
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D001685:Biological Factors / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D000069285:Infliximab; D008137:Longitudinal Studies; D008297:Male; D009894:Opportunistic Infections / Q000139:chemically induced / Q000453:epidemiology*; D010349:Patient Compliance; D011565:Psoriasis / Q000139:chemically induced / Q000453:epidemiology*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014605:Uveitis / Q000139:chemically induced / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001685:Biological Factors; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000410:Alanine Transaminase; D000068879:Adalimumab; D000068800:Etanercept
keywords: adverse drug event; anti-TNF; anti-rheumatic agent; biologic therapy; disease-modifying anti-rheumatic drug; juvenile idiopathic arthritis