Background
Methods
Information sources and search
Eligiblity and exclusion criteria
Indication | Population |
---|---|
JIA | Polyarticular rheumatoid factor positive/negative JIA (PJIA) |
Persistent or extended oligoarticular JIA (OJIA) | |
Enthesitis-related juvenile idiopathic arthritis and juvenile ankylosing spondylitis, including sacroiliitis (ERA) | |
Psoriatic juvenile idiopathic arthritis (PsA) | |
Systemic JIA (SJIA) | |
Uveitis | JIA-associated uveitis |
Non-infectious uveitis | |
Autoinflammatory Diseases | Familial Mediterranean Fever (FMF) |
TNF receptor-1 associated periodic syndrome (TRAPS) | |
Cryopyrin-associated periodic syndromes (CAPS) | |
Mevalonate Kinase Deficiency (MKD)/Hyperimmunoglobulin D syndrome (HIDS) | |
Unclassified periodic fever syndromes | |
Chronic recurrent multifocal osteomyelitis (CRMO) and Majeed syndrome | |
Deficiency of the interleukin-1 receptor antagonist (DIRA) | |
A20 haploinsufficiency (HA20) | |
Sideroblastic anemia with B cell immunodeficiency, periodic fevers and developmental delay syndrome (SIFD) | |
Pyogenic arthritis, pyoderma gangraenosum and acne (PAPA) | |
Deficiency of the interleukin-36 receptor antagonist (DITRA) | |
Palmar plantar pustulosis (PPP) | |
Pyoderma gangraenosum | |
Interferonopathy | Chronic atypical neutrophilic dermatitis with lipodystrophy and elevated temperature (CANDLE) Stimulator of interferon genes-associated vasculopathy with onset in infancy (SAVI) |
Vasculitis | Takayasu arteritis |
Leucocytoclastic vasculitis | |
Granulomatosis with polyangiitis (GPA), Wegener’s Granulomatosis | |
Polyarteritis nodosa | |
Microscopic polyangiitis (MPA) | |
Eosinophilic granulomatosis with polyangiitis | |
Kawasaki Disease (KD) | |
Behcet disease | |
Connective Tissue Diseases | Systemic Lupus Erythematosus (SLE) |
Juvenile Dermatomyositis (JDM) | |
Paediatric sarcoidosis | |
Systemic and Localized Scleroderma | |
Sjögren Syndrome | |
Mixed connective tissue diseases (MCTD) | |
Macrophage activation syndrome | |
Psoriasis |
Study selection and data collection process
Results
Study selection
Drug Class | Drug | Studies | Arms | Patients | Indications | Populations |
---|---|---|---|---|---|---|
Anti-CD 20 agent | rituximab | 0 | ||||
CD80/86 inhibitor | abatacept | 1 | 2 | 190 | JIA | PJIA, SJIA (without systemic features), extended OJIA |
IL-1 inhibitor | anakinra | 2 | 4 | 110 | JIA | PJIA, SJIA |
canakinumab | 2 | 4 | 261 | JIA | SJIA | |
rilonacept | 2 | 5 | 95 | JIA | SJIA | |
IL-6 inhibitor | sarilumab | 0 | ||||
tocilizumab | 3 | 6 | 356 | JIA | PJIA, extended OJIA, SJIA | |
IL-12/23 inhibitor | ustekinumab | 1 | 3 | 110 | Psoriasis | Plaque psoriasis |
IL-23 inhibitor | guselkumab | 0 | ||||
risankizumab | 0 | |||||
tildrakizumab | 0 | |||||
IL-17 inhibitor | brodalumab | 0 | ||||
ixekizumab | 1 | 3 | 201 | Psoriasis | Plaque psoriasis | |
secukinumab | 0 | |||||
TNF inhibitor | adalimumab | 6 | 13 | 485 | JIA, psoriasis, uveitis | ERA, JIA-associated uveitis, PJIA, plaque psoriasis |
etanercept | 8 | 17 | 746 | JIA, psoriasis, vasculitis | PJIA, OJIA, PsA, ERA, SJIA, plaque psoriasis, KD | |
golimumab | 1 | 2 | 154 | JIA | PJIA, SJIA (without systemic features), PsA | |
infliximab | 6 | 13 | 576 | JIA, uveitis, vasculitis | PJIA, non-infectious uveitis, KD | |
certolizumab pegol | 0 | |||||
BAFF inhibitor | belimumab | 1 | 2 | 93 | CTD | SLE |
JAK inhibitor | tofacitinib | 1 | 2 | 225 | JIA | ERA, PJIA, PsA |
baricitinib | 0 | |||||
upadacitinib | 0 |
Drug class | Drug | Study | Sponsor | Population | Region | Study duration | Primary outcome/endpoint |
---|---|---|---|---|---|---|---|
CD 80/86 inhibitor | abatacept | Limit-JIA, NCT03841357 | Duke University | OJIA | United States | 10/2019–12/2022 | Joint count, active anterior uveitis |
IL-23 inhibitor | guselkumab | aPROTOSTAR, NCT03451851 | Janssen | Paediatric psoriasis | global | 7/2018–6/2025 | PASI75, PGA ≤1 |
risankizumab | bM19–977, NCT04435600 | Abbvie | Paediatric psoriasis | United States | 7/2020–06/2025 | PASI75; PGA ≤ 1 | |
tildrakizumab | TILD-19-12, NCT03997786 | Sun Pharma Global FZE | Paediatric psoriasis | United States | 1/2020–11/2023 | PASI75, PGA ≤1 | |
IL-17 inhibitor | brodalumab | cEMBRACE 1, NCT04305327 | LEO Pharma | Paediatric psoriasis | global | 9/2020–11/2023 | PASI75 |
secukinumab | dCAIN457F2304, NCT03031782 | Novartis | PsA, ERA | global | 5/2017–12/2020 | Disease flare | |
eCAIN457A2311, NCT03668613 | Novartis | Paediatric psoriasis | global | 8/2018–9/2023 | PASI75, PGA ≤1 | ||
fCAIN457A2310, NCT02471144 | Novartis | Paediatric psoriasis | global | 9/2015–7/2023 | PASI75, PGA ≤1 | ||
TNF inhibitor | adalimumab | gADJUST, NCT03816397 | UCSF | JIA-associated uveitis | United States | 12/2019–12/2022 | Treatment failure |
etanercept | STARS, EudraCT 2018–001931-27 | IRCCS Istituto Giannina Gaslini | OJIA, PJIA | Italy | NA | Clinical inactive disease | |
infliximab | KIDCARE, NCT03065244 | UCSD | Kawasaki disease | United States | 2/2017–9/2020 | Fever | |
certolizumab pegol | CIMcare, NCT04123795 | UCB Biopharma | Paediatric psoriasis | North America | 1/2020–4/2023 | PASI75, PGA ≤1 | |
JAK inhibitor | baricitinib | hJUVE-BRIGHT, NCT04088409 | Eli Lilly | JIA-associated uveitis | Europe | 10/2019–7/2022 | Uveitis disease response |
iJUVE-BALM, NCT04088396 | Eli Lilly | SJIA | global | 2/2020–4/2023 | Disease flare | ||
jJUVE-BASIS, NCT03773978 | Eli Lilly | PJIA, extended OJIA, ERA, PsA | global | 12/2018–8/2021 | Disease flare | ||
tofacitinib | A3921165, NCT03000439 | Pfizer | SJIA | global | 5/2018–8/2023 | Disease flare |
Study characteristics
Drug class | Drug | Dose | Study (phase) | Study timec | Population | N | Age criteria | Agea | Background | Primary outcome/endpoint | Main conclusion |
---|---|---|---|---|---|---|---|---|---|---|---|
CD80/86 inhibitor | abatacept | 10 mg/kg q4w | dIM101–033, NCT00095173 | 26 | PJIA, SJIA (without systemic features), extended OJIA | 190 | 6 to 17 | 12.4 | MTX, corticosteroids | Disease flare | Effective |
IL-1 inhibitor | anakinra | 1 mg/kg/d | 16 | PJIA | 86 | 2 to 17 | 12 | MTX | Safety | Efficacy is inconclusive | |
2 mg/kg/d | ANAJIS, NCT00339157 | 4.33 | SJIA | 24 | 2 to 20 | 8.5 | NSAID, corticosteroids | Modified ACR Pedi 30 | Effective | ||
canakinumab | 4 mg/kg single dose | 4.33 | SJIA | 84 | 2 to 19 | 8a | MTX, NSAID, corticosteroids | ACR Pedi 30 | Effective | ||
4 mg/kg q4w | 120 | SJIA | 177 | 2 to 19 | 8a | MTX, NSAID, corticosteroids | Disease flare | Effective | |||
rilonacept | 2.2 mg/kg qw | RAPPORT, NCT00534495 | 24 | SJIA | 71 | 1 to 19 | 10 | NA | Modified ACR Pedi 30 | Effective | |
2.2 mg/kg qw, 4.4 mg/kg qw | IL1T-AI-0504, NCT01803321 (II) [60] | 104 | SJIA | 24 | 4 to 20 | 12.6 | MTX, NSAID, corticosteroids | ACR Pedi 30 | Not effective | ||
IL-6 inhibitor | tocilizumab | 8 mg/kg q4w, 10 mg/kg q4w | hCHERISH, NCT00988221 | 104 | PJIA, extended OJIA | 188 | 2 to 17 | 11 | MTX, corticosteroids | Disease flare | Effective |
8 mg/kg q2w, 12 mg/kg q2w | iTENDER, NCT00642460 | 260 | SJIA | 112 | 2 to 17 | 9.7 | MTX, corticosteroids | Modified ACR Pedi 30 | Effective | ||
8 mg/kg q2w | MRA316JP, NCT00144599 (III) [68]b | 18 | SJIA | 56 | 2 to 19 | 8.3 | corticosteroids | ACR Pedi 30 | Effective | ||
TNF inhibitor | adalimumab | 24 mg/m2 q2w | jM11–328, NCT01166282 | 12 | ERA | 46 | 6 to 17 | 12.9 | MTX or SSZ, NSAID | Joints with active arthritis | Effective |
40 mg q2w | Horneff 2012, EudraCT 2007–003358-27(III) [72] | 12 | ERA | 32 | 12 to 17 | 15.3 | NSAID, corticosteroids | ASAS40 | Effective | ||
24 mg/m2 q2w | k,bDE038, NCT00048542 | 48 | PJIA | 171 | 4 to 17 | 11.2 | MTX, NSAID, corticosteroids | Disease flare | Effective | ||
20 mg q2w, 40 mg q2w | 78 | JIA-associated uveitis | 90 | 2 to 18 | 8.9 | MTX | Treatment failure | Effective | |||
24 mg/m2 q2w, 40 mg q2w | lADJUVITE, NCT01385826 (II/III) [77] | 52 | JIA-associated uveitis | 32 | > = 4 | 9.5a | MTX, corticosteroids (oral and topical) | LFP improvement > = 30% and no worsening on slit lamp | Effective | ||
etanercept | 0.8 mg/kg/qw | Horneff 2015, EudraCT 2010–020423-51 (III) [78] b | 48 | ERA | 38 | 6 to 17 | 13.3 | SSZ, NSAID, corticosteroids | Disease flare | Effective | |
0.8 mg/kg/qw | 30.33 | PJIA | 69 | 4 to 17 | NA | NSAID, corticosteroids | Disease flare | Effective | |||
0.8 mg/kg/qw | o20021616, NCT03780959 (II/III) [81]b | 30.33 | PJIA | 69 | 4 to 18 | 10.5 | NSAID | Disease flare | Effective | ||
0.8 mg/kg/qw | 20021628, NCT03781375 (III) [82] | 52 | PJIA | 25 | NA | 10.1 | MTX | ACR Pedi 30 | NA | ||
0.8 mg/kg/qw | TREAT, NCT00443430 | 52 | PJIA | 85 | 2 to 17 | 10.5 | MTX | Clinical inactive disease | Not effective | ||
0.8 mg/kg/qw, 1.6 mg/kg/qw | b20021631, NCT00078806 (III) [85] | 39 | SJIA | 19 | 2 to 18 | 9.1 | MTX, NSAID, corticosteroids | Disease flare | NA | ||
0.8 mg/kg/qw | 12 | PJIA,RF−; OJIA, JPsA | 94 | 2 to 16 | 8.8a | MTX | Unclear | Effective | |||
golimumab | 30 mg/m2 q4w | 48 | PJIA, SJIA (without systemic features), PsA | 154 | 2 to 17 | 11.1 | MTX, corticosteroids | Disease flare | Not effective | ||
infliximab | 3 mg/kg, 6 mg/kg | CR004774, NCT00036374 (III) [90] | 58 | PJIA | 122 | 4 to 17 | 11.2 | MTX, NSAID, corticosteroids | ACR Pedi 30 | Not effective | |
3–5 mg/kg | ACUTE-JIA, NCT01015547 (III) [91] | 54 | PJIA | 60 | 4 to 15 | 9.6 | MTX, other DMARDs | ACR Pedi 75 | Effective | ||
JAK inhibitor | tofacitinib | 2–5 mg BID | nA3921104, NCT02592434 (III) [92]b | 44 | ERA, PJIA, PsA | 225 | 2 to 17 | 13a | NA | Disease flare | Effective |
Drug class | Drug | Dose | Study (phase) | Studytimec | Population | N | Age criteria | Agea | Primary outcome/endpoint | Main conclusion |
---|---|---|---|---|---|---|---|---|---|---|
IL-12/23 inhibitor | ustekinumab | 0.75 mg/kg, 22.5/45/ 90 mg | dCADMUS, NCT01090427 (III) [93]b | 60 | Plaque psoriasis | 110 | 12 to 17 | 15.2 | PGA ≤1 | Effective |
IL-17 inhibitor | ixekizumab | 20 mg BW < 25 kg q4w, 40 mg BW 25–50 kg q4w, 80 mg BW > 50 kg q4w | eIXORA-PEDS, NCT03073200 (III) [94] b | 12 | Plaque psoriasis | 201 | 6 to 17 | 13.5 | PASI75, PGA ≤1 | Effective |
TNF inhibitor | adalimumab | 0.4 mg/kg q2w, 0.8 mg/kg q2w | fM04–717, NCT01251614 | 52 | Plaque psoriasis | 114 | 4 to 17 | 13 | PASI75, PGA ≤1 | Effective |
etanercept | 0.8 mg/kg/qw | EATAK, NCT00841789 (II) [99] b | 6 | KD | 205 | 0 to 18 | 3.7 | Fever | Not effective | |
0.8 mg/kg/qw | 20030211, NCT00078819 | 48 | Plaque psoriasis | 211 | 4 to 17 | 13a | PASI75 | Effective | ||
infliximab | 5 mg/kg single dose | Han 2018 (NA) [105] b | 0.571 | KD | 154 | 0 to 4 | 2.2a | Unclear | Effective | |
5 mg/kg single dose | TA-650-22, NCT01596335 (III) [106] b | 8 | KD | 31 | 1 to 10 | 3a | Defervescence | Effective | ||
5 mg/kg single dose | 5 | KD | 196 | 0 to 17 | 3a | Fever | Effective | |||
5 mg/kg, 10 mg/kg q4w | Pro00000057, NCT00589628 (IV) [109] b | 39 | Non-infectious uveitis | 13 | 4 to 18 | NA | Uveitis disease activity | NA | ||
BAFF inhibitor | belimumab | 10 mg/kg qm | gPLUTO, NCT01649765 | 52 | SLE | 93 | 5 to 17 | 14 | SRI4 | Effective |
Approved bDMARDs and JAK inhibitors in paediatric and adult rheumatology
Drug class | Drug (brand name) | Adults | Children | ||||
---|---|---|---|---|---|---|---|
Approved by FDA (date) | Approved by EMA (date) | Approved by FDA (date) | Current FDA age criteria | Approved by EMA (date) | Current EMA age criteria | ||
Anti-CD20 agent | rituximaba (MabThera, Rituxan) | RA (2006), WG/MPA (2011) | RA(2006), GPA/MPA (2013) | GPA/MPA (2019) | ≥2 years | GPA/MPA (2020) | ≥2 years |
CD80/86 inhibitor | abatacept (Orencia) | RA (2005), PsA (2017) | RA (2007), PsA (2017) | PJIA (2008) | ≥2 years (sc); ≥6 years (iv) | PJIA (2009) | ≥2 years |
IL-1 inhibitor | anakinra (Kineret) | RA (2001) CINCA/NOMID (2012) | RA (2002), CAPS (2013), AOSD (2018) | NOMID/CINCA (2012) | NA | CAPS (2013), SJIA (2018) | ≥8 months |
canakinumab (Ilaris) | CAPS (2009), TRAPS/MKD/FMF (2016) | CAPS (2009), AOSD (2016), TRAPS/FMF/MKD (2016) | CAPS (2009), SJIA (2013), TRAPS/ FMF/MKD (2016) | ≥4 years CAPS/TRAPS/MKD/ FMF; ≥2 years SJIA | CAPS (2009), SJIA (2013), TRAPS/FMF/ MKD (2016) | ≥2 years | |
rilonacept (Arcalyst) | CAPS (2008) | not approved | CAPS (2008) | ≥12 years | not approved | ||
IL-6 inhibitor | tocilizumabb (RoAcetemra/Actemra) | RA (2010) | RA (2008) | SJIA (2011), PJIA (2013) | ≥2 years | SJIA (2011), PJIA (2013) | ≥1 years SJIA; ≥2 years PJIA |
sarilumab (Kevzara) | RA (2017) | RA (2017) | not approved | not approved | |||
IL-12/23 inhibitor | ustekinumabc (Stelara) | Plaque psoriasis (2009), PsA (2013) | Plaque psoriasis (2008), PsA (2014) | Plaque psoriasis (2017) | ≥12 years | Plaque psoriasis (2015) | ≥6 years |
IL-23 inhibitor | guselkumab (Tremfya) | Plaque psoriasis (2017) | Plaque psoriasis (2017) | not approved | not approved | ||
risankizumab (Skyrizi) | Plaque psoriasis (2019) | Plaque psoriasis (2019) | not approved | not approved | |||
tildrakizumab (Ilumya/Ilumetri) | Plaque psoriasis (2018) | Plaque psoriasis (2018) | not approved | not approved | |||
IL-17 inhibitor | brodalumab (Siliq, Kyntheum) | Plaque psoriasis (2017) | Plaque psoriasis (2017) | not approved | not approved | ||
ixekizumab (Taltz) | Plaque psoriasis (2016), PsA (2017), AS (2019) | Plaque psoriasis (2016), PsA (2017) | Plaque psoriasis (2020) | ≥6 years | not approved | ||
secukinumab (Cosentyx) | Plaque psoriasis (2015), AS (2016), PsA (2016) | Plaque psoriasis (2014), PsA (2015), AS (2015) | not approved | not approved | |||
TNF inhibitor | adalimumabd (Humira) | RA (2002), PsA (2005), AS (2006), plaque psoriasis (2008), non-infectious intermediate, posterior and panuveitis (2016) | RA (2003), PsA (2005), AS (2006), plaque psoriasis (2007), non-radiographic axial spondyloarthritis (2012), non-infectious intermediate, posterior and panuveitis (2016) | PJIA (2008) | ≥2 years | PJIA (2008), ERA (2014), plaque psoriasis (2015), non-infectious anterior uveitis (2017) | ≥2 years PJIA; ≥2 years uveitis; ≥4 years plaque psoriasis; ≥6 years ERA |
certolizumab pegole (Cimzia) | RA (2009), PsA (2013), AS (2013), plaque psoriasis (2018), non-radiographic axial spondyloarthritis (2019) | RA (2009), PsA (2013), AS/non-radiographic axial spondyloarthritis (2013), plaque psoriasis (2018) | not approved | not approved | |||
etanercept (Enbrel) | RA (1998), PsA (2002), AS (2003), plaque psoriasis (2004) | RA (2000), PsA (2002), AS (2004), plaque psoriasis (2004), non-radiographic axial spondyloarthritis (2014) | PJIA (1999), plaque psoriasis (2016) | ≥2 years PJIA; ≥4 years plaque psoriasis | PJIA (2001), plaque psoriasis (2008), ERA/PsA (2012) | ≥2 years PJIA; ≥6 years plaque psoriasis; ≥12 years ERA/PsA | |
golimumabf (Simponi) | RA/PsA/AS (2009) | RA/PsA/AS (2009), non-radiographic axial spondyloarthritis (2015) | not approved | PJIA (2016) | ≥2 years | ||
infliximabg (Remicade) | RA (1999), AS (2004), PsA (2005), plaque psoriasis (2006) | RA (2000), AS (2003), PsA (2004), plaque psoriasis (2005) | not approved | not approved | |||
BAFF inhibitor | belimumab (Benlysta) | SLE (2011) | SLE (2011) | SLE (2019) | ≥5 years | SLE (2019) | ≥5 years |
JAK inhibitor | tofacitinib8 (Xeljanz) | RA (2012), PsA (2017) | RA (2017), PsA (2018) | not approved | not approved | ||
baricitinib (Olumiant) | RA (2018) | RA (2016) | not approved | not approved | |||
upadacitinib (Rinvoq) | RA (2019) | RA (2019) | not approved | not approved |