“Many adult rheumatologists I work with may be very aggressive in treating arthritis in adults, but are unsure just how aggressive to be in children,” agreed Dr. Passo, professor in the division of pediatric rheumatology at the Medical University of South Carolina in Charleston.
“With children, there are long-term side effects to worry about.”
So far, the side-effect profile for children with JIA who take biologics has largely been benign. Nevertheless, the drugs are new and their effect on children's health is not fully known.
The FDA is conducting an ongoing safety review of TNF blockers in children and young adults who are being treated for a wide variety of conditions, including Crohn's disease, as well as JIA. The FDA reported in a June 4, 2008, communication that 30 cancers—half of them lymphomas—had been reported in young people who were prescribed biologic therapies.
“Quite honestly, malignancy has not been a big issue” in the JIA population, said Dr. Passo. “The pediatric population does not have the same propensity for lymphoma as [do] adults with rheumatoid arthritis and lupus, at least not that we have been able to prove.
“Having said that, there are a few case reports of malignancy and serious opportunistic infections. These have not been quite as severe, at least in my experience, in kids as they are in adults.