Biologicals for children and adolescents in the treatment of rheumatic diseases

Following pharmacolegal measures several biologic agents have been tested in children and adolescents with rheumatic diseases, mainly juvenile idiopathic arthritis (JIA), in controlled trials and have been introduced into treatment algorithms. This was achieved by international research cooperation and after introduction of well-defined criteria for disease entities, disease activity, improvement and deterioration. Etanercept, adalimumab, abatacept, tocilizumab and canakinumab have obtained limited licenses. Etanercept is the longest available biologic agent. Etanercept or adalimumab are the treatment of choice when methotrexate is not sufficient or toxic in children with polyarthritis. Tocilizumab is given to patients with systemic JIA when glucocorticoids fail or become toxic. These and other biologic agents including anakinra and rituximab are effectively applied also off label; however, there is a lack of long-term studies. These drugs should be prescribed only by pediatric rheumatologists.