Background: Although various biologic agents (BAs) are in use for polyarticular juvenile idiopathic arthritis (pJIA), a combined meta-analytic summary comparing the efficacy and safety among them in pJIA is lacking. Objective: To compare the efficacy and safety of BAs in pJIA. Methods: A systematic search of MEDLINE, EMBASE, CENTRAL and clinicaltrials.gov was performed. Eligible wRCTs included patients with pJIA where BAs, at any dose, were compared with another BA or placebo. Efficacy was evaluated with disease flare and ACRPedi30, 50, and 70. Safety was evaluated by adverse events (AEs) and serious AEs (SAEs). Two reviewers extracted data, and a third confirmed. A network meta-analysis was used to compare BAs, based on a mixed-effects logistic regression model (modeled in SAS). Results are reported as OR [95%CI]. Results: Of 490 references identified 5 wRCTs were included: abatacept, adalimumab, anakinra, etanercept and tocilizumab, one trial each, all vs. placebo. Nearly all placebo comparisons showed statistically significant efficacy (P < 0.05) for flare and for ACRPedi 30, 50 and 70; etanercept was not different for ACRpedi70 (2.30 [0.73;7.29]; P = 0.16). SAEs occurred very infrequently (0-8%). There were no differences for AEs when compared to placebo or among BAs. Conclusion: Overall BAs were effective and safe when compared placebo. There were no differences among BAs for either efficacy or safety. Based on these data, other considerations such as price and availability should be used to decide among BAs when treating pJIA patients as no personalized biomarkers etc. are presently available.
