How do I ensure safe use of biological agents in children and adolescents with rheumatic diseases?

摘要

Biologic agents are genetically engineered drugs designed to target specific areas of the immune system and selectively block inflammatory pathways implicated in disease processes. They include monoclonal antibodies, soluble cytokine receptors and recombinant receptor antagonists (summarized in Table 1). Used successfully in patients failing conventional disease-modifying anti-rheumatic drug (DMARD) therapy, their benefit has consequentially led to a shift in the paradigm of treatment of several inflammatory diseases, particularly juvenile idiopathic arthritis (JIA), making remission an achievable target. In JIA the efficacy of biologic therapies has been shown in a number of landmark clinical trials made possible through multicentre international collaboration. In addition, there are several reports of the safety and efficacy of biologies in a range of other inflammatory conditions. Outcomes such as elimination of any pain and inflammation, normalization of short-term and long-term function and achievement of normal growth, physical and psychosocial development are now realistic priorities for clinicians and patients.