The Resource Disease-modifying antirheumatic drugs (DMARDs) in children with juvenile idiopathic arthritis (JIA), prepared for Agency for Healthcare Research and Quality ; prepared by Duke Evidence-based Practice Center ; investigators, Alex R. Kemper [and others], (electronic resource)

Disease-modifying antirheumatic drugs (DMARDs) in children with juvenile idiopathic arthritis (JIA), prepared for Agency for Healthcare Research and Quality ; prepared by Duke Evidence-based Practice Center ; investigators, Alex R. Kemper [and others], (electronic resource)

Label
Disease-modifying antirheumatic drugs (DMARDs) in children with juvenile idiopathic arthritis (JIA)
Title
Disease-modifying antirheumatic drugs (DMARDs) in children with juvenile idiopathic arthritis (JIA)
Statement of responsibility
prepared for Agency for Healthcare Research and Quality ; prepared by Duke Evidence-based Practice Center ; investigators, Alex R. Kemper [and others]
Contributor
Subject
Genre
Language
eng
Summary
OBJECTIVES: To summarize the benefits and harms of disease-modifying antirheumatic drugs (DMARDs) compared to conventional treatment (non-steroidal anti-inflammatory drugs [NSAIDs] and/or intra-articular corticosteroids) with or without methotrexate, and of the various DMARDs compared to one another, in children with juvenile idiopathic arthritis (JIA); and to describe selected tools commonly used to measure clinical outcomes associated with JIA. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. Additional studies were identified from the review of reference lists. REVIEW METHODS: To evaluate efficacy, we included prospective trials that included a comparator and that lasted for at least 3 months. No comparator was required for reports of adverse events or of the clinical outcome measure tools. RESULTS: A total of 198 articles were included. There is some evidence that methotrexate is superior to conventional treatment (NSAIDs and/or intra-articular corticosteroids). Among children who have responded to a biologic DMARD, randomized discontinuation trials suggest that continued treatment decreases the risk of having a flare. Although these studies evaluated DMARDs with different mechanisms of action (abatacept, adalimumab, anakinra, etanercept, intravenous immunoglobulin, tocilizumab) and used varying comparators, followup periods, and descriptions of flare, the finding of a reduced risk of flare was precise and consistent. There are few direct comparisons of DMARDs, and insufficient evidence to determine if any specific drug or drug class has greater beneficial effects. Reported rates of adverse events are similar between DMARDs and placebo in nearly all published randomized controlled trials. This review identified 11 incident cases of cancer among several thousand children treated with one or more DMARD. The Childhood Health Assessment Questionnaire (CHAQ) was the most extensively evaluated instrument of those considered. While it demonstrated high reproducibility and internal consistency, it had only moderate correlations with indices of disease activity and quality of life, and poor to moderate responsiveness. 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 symptoms associated with JIA. Limited data suggest that short-term risk of cancer is low. Future trials are needed to evaluate the effectiveness of DMARDs against both conventional therapy and other DMARDs across categories of JIA, and registries are needed to better understand the risks of these drugs
Member of
Cataloging source
NLM
Funding information
Prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
QV 247
http://library.link/vocab/relatedWorkOrContributorName
  • Kemper, Alex R
  • United States
  • Duke University Evidence-based Practice Center
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness reviews
  • AHRQ publication
Series volume
  • no. 28
  • no. 11-EHC039-EF
http://library.link/vocab/subjectName
  • Antirheumatic Agents
  • Arthritis, Juvenile
http://bibfra.me/vocab/relation/supportingbody
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Label
Disease-modifying antirheumatic drugs (DMARDs) in children with juvenile idiopathic arthritis (JIA), prepared for Agency for Healthcare Research and Quality ; prepared by Duke Evidence-based Practice Center ; investigators, Alex R. Kemper [and others], (electronic resource)
Instantiates
Publication
Note
"September 2011."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
txt
Content type MARC source
rdacontent
Control code
774949106
Extent
1 online resource
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)774949106
Label
Disease-modifying antirheumatic drugs (DMARDs) in children with juvenile idiopathic arthritis (JIA), prepared for Agency for Healthcare Research and Quality ; prepared by Duke Evidence-based Practice Center ; investigators, Alex R. Kemper [and others], (electronic resource)
Publication
Note
"September 2011."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
txt
Content type MARC source
rdacontent
Control code
774949106
Extent
1 online resource
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)774949106

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