The authors stated that 15 studies were included: one randomised controlled trial (RCT) (n=69), one non-RCT (n=24), 10 uncontrolled trials (n=497) and three case series (n=38, but not reported for one study). Details of related studies were tabulated. The RCT and non-RCT were both rated as fair quality. Three of the uncontrolled trials were rated as good quality, nine were fair and one was poor. All three case series were rated fair quality.
One RCT and six uncontrolled trials reported that etanercept improved symptoms; four of these studies suggested that patients with systemic juvenile idiopathic arthritis had lower response rates than patients with polyarticular juvenile idiopathic arthritis. In the RCT, frequencies of adverse events did not differ between the etanercept and placebo groups.
There were three studies of infliximab; overall there was a suggestion of general efficacy, but also high rates of infusion reactions and adverse events. One of the two uncontrolled studies reported no additional benefit in patients who had failed etanercept.
Two small uncontrolled studies suggested that tocilizumab was efficacious.