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Article Dans Une Revue Rheumatology Année : 2020

The benefit–risk balance for biological agents in juvenile idiopathic arthritis: a meta-analysis of randomized clinical trials

Natalia Cabrera
Gabriela Avila-Pedretti
  • Fonction : Auteur
Alexandre Belot
  • Fonction : Auteur
Jean-Paul Larbre
  • Fonction : Auteur
Sabine Mainbourg
Agnès Duquesne
  • Fonction : Auteur
Perrine Janiaud
  • Fonction : Auteur
Behrouz Kassai
  • Fonction : Auteur
Michel Cucherat
  • Fonction : Auteur

Résumé

Abstract Objective To assess the net benefit of biological agents (BA) used in JIA. Methods We systematically searched databases up to March 2019 for randomized controlled trials (RCT) performed in JIA disease. Separate random-effects meta-analyses were conducted for efficacy (ACR paediatric score 30%, ACRpedi30) and serious adverse events for safety. In order to standardize the baseline risk, we performed a meta-analysis of baseline risk in the control group (for both efficacy and safety meta-analysis). The net benefit was determined as the risk difference of efficacy subtracted by the risk difference of safety. Results We included 19 trials: 11 parallel RCTs (754 patients) and 8 withdrawal RCTs (704 patients). The net benefit ranged from 2.4% (adalimumab) to 17.6% (etanercept), and from 2.4% (etanercept) to 36.7%, (abatacept) in parallel and withdrawal trials assessing non-systemic JIA, respectively. In the systemic JIA category, the net benefit ranged from 22.8% (rilonacept) to 70.3% (canakinumab), and from 32.3% (canakinumab) to 58.2% (tocilizumab) in parallel and withdrawal trials, respectively. Conclusion The results suggest that a greater number of patients experienced therapeutic success without serious adverse events in the systemic onset JIA category compared with the BAs for non-systemic JIA categories. Baseline risk, design of trial and JIA categories impact the measure of net benefit of BAs in JIA patients.

Dates et versions

hal-04629111 , version 1 (28-06-2024)

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Citer

Natalia Cabrera, Gabriela Avila-Pedretti, Alexandre Belot, Jean-Paul Larbre, Sabine Mainbourg, et al.. The benefit–risk balance for biological agents in juvenile idiopathic arthritis: a meta-analysis of randomized clinical trials. Rheumatology, 2020, 59 (9), pp.2226-2236. ⟨10.1093/rheumatology/keaa170⟩. ⟨hal-04629111⟩
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