Should the food and drug administration warning of malignancy in children receiving tumor necrosis factor α blockers change the way we treat children with juvenile idiopathic arthritis?

摘要

The article by Diak et al (1) in this issue of Arthritis & Rheumatism raises a very important set of questions for the practice of pediatric rheumatology. Is there a significant increase in the risk of malignancy in children with juvenile idiopathic arthritis (JIA) treated with tumor necrosis factor a (TNFo:) blockers? Do the potential risks outweigh the benefits? Answering these questions requires a careful evaluation of the data presented.Diak et al report 48 cases of malignancies occurring in children receiving TNFa blockers (infliximab, etanercept, and adalimumab). However, 25 of these cases occurred in children with inflammatory bowel disease (IBD), and all of these 25 children had received concomitant immunosuppressants. Although some controversy continues, most pediatric gastroenterologists now accept that there is an increased risk of a previously rare intestinal T cell lymphoma in children receiving TNFa blockers and concomitant purine analogs for IBD (2). Pediatric rheumatologists must be aware of these data, but this finding is not of direct relevance to children with JIA.