Long-term Biological Treatment in Juvenile Idiopathic Arthritis: Benefits and Risks

The advent of biologic medication has substantially improved the evolution of juvenile idiopathic arthritis (JIA), producing better social insertion and a clearly superior quality of life. However, there is a possibility of immunological disorders following treatment with biological substances, which may have long-term consequences in treated patients. The extension of clinical trials to pediatric patients has allowed a closer follow-up of both the evolution of the disease under treatment and the consequences of biological treatments. This article aims to analyze this aspect according to studies conducted in many countries by several authors. For each biological agent, the immunological events consisted primarily of the appearance of serious infections, such as tuberculosis, malignancies, response to vaccines, the appearance of autoimmune manifestations, and, last but not least, the appearance of anti-drug antibodies. These studies have shown that there are large differences in side effects between different biological agents, and, therefore, it has been proposed that a dossier be conducted to monitor these side effects. An international pharmacovigilance database called PharmaChild has already been created.