Gene engineering biological therapy for juvenile arthritis

Abstract

The mechanisms of action of currently used genetic engineering biological agents (GEBAs) include inhibition of cytokines, interleukins, and T cells and depletion of B cells. GEBAs were originally accessible mainly for the treatment of refractory juvenile idiopathic arthritis (JIA), including systemic-onset JIA (Still's disease), which allowed one to do away with the long-term use of high doses of glucocorticoids or cytostatics. Since 2000, a number of randomized double-blind placebo-controlled and open-label pilot studies have convincingly demonstrated the efficacy of GEBAs in children and adolescents. Although the tumor necrosis factor-a (TNF-a) inhibitors etanercept and adalimumab are chiefly used to treat refractory polyarticular JIA, interleukin 1 and 6 blockers showed satisfactory results in treating systemic JIA. Abacept is regarded as a treatment option for patients with polyarticular JIA when disease modifiers and TNF-a inhibitors are ineffective. The place of rituximab in the management of JIA has not certainly defined so far. However, GEBA therapy cannot completely cure the disease as before despite the progress achieved. GEBAs have potentially a number of serious side effects, among which there are severe infections and there is a risk of developing malignancies and autoimmune processes. Their administration requires careful monitoring to reveal the early development of serious adverse reactions, thus preventing a poor outcome.

Keywords

• genetic engineering biological agents in children
• juvenile arthritis
• biological therapy for juvenile arthritis