Comparison of the efficacy and safety of biological agents in patients with systemic juvenile idiopathic arthritis: A Bayesian network meta-analysis of randomized controlled trials

Objective To assess the relative efficacy and safety of biological agents in patients with systemic juvenile idiopathic arthritis (sJIA). Materials and methods We performed a Bayesian network meta-analysis to combine direct and indirect evidence from randomized controlled trials (RCTs) to examine the efficacy and safety of canakinumab, anakinra, tocilizumab, and rilonacept in patients with sJIA. Results Five RCTs that included 286 patients met the inclusion criteria. Canakinumab was the most effective treatment for sJIA (odds ratio, 55.04; 95% credible interval, 15.52 - 253.29). A greater efficacy was observed with canakinumab than with tocilizumab and rilonacept. All interventions achieved a significant modified American College of Rheumatology Pediatric 30 (ACRpedi30) response compared to the placebo. The ranking probability, based on the surface under the cumulative ranking curve, indicated that canakinumab had the highest probability of being the best treatment in terms of the modified ACRpedi30 response rate, followed by anakinra, tocilizumab, rilonacept, and the placebo. However, no significant differences were observed in the incidence of serious adverse events after treatment with canakinumab, anakinra, tocilizumab, rilonacept, or the placebo. Conclusion In patients with sJIA, canakinumab had the highest probability of being the best treatment in terms of the modified ACRpedi30 response rate; neither of the tested biological agents were associated with a significant risk of serious adverse events.