Pediatrics Debate to Weigh Use of Biologics to Treat sJIA

Biologic medications have yielded a remarkable advancement in the treatment of many pediatric patients with systemic juvenile idiopathic arthritis (sJIA), but not all. Researchers and physicians began to question their use after some children treated with the drugs developed interstitial lung disease (ILD).

“How you read the literature and what you think about it depends very much on changing clinical practice, how we monitor these children, how we treat them,” said Karen B. Onel, MD, Chief of the Pediatric Rheumatology Division at the Hospital for Special Surgery, New York City. “So, it’s important for us to have this conversation.”

It’s this unresolved issue that is up for discussion during the Pediatrics Great Debate: To Treat or Not to Treat sJIA–Lung Disease with Biologics. At the heart of the debate is whether using biologics that revolutionized the care of many children with sJIA is the right thing to do given concerns that some children could be seriously harmed or die. Another key element is whether to screen for lung disease among those treated with the drugs.

The session will take place on Sunday, Nov. 17, from 10:30–11:30 a.m. ET in Room 202AB of the Walter E. Washington Convention Center, when Dr. Onel will debate Randy Cron, MD, PhD, Director of the Division of Pediatric Rheumatology at the University of Alabama, Birmingham. The pair did not want to reveal who will argue which side of the debate. The session will be available on demand within 48 hours for registered ACR Convergence 2024 participants.

“We know that there is a lung disease that is affecting our children, our patients with sJIA,” Dr. Onel said. “There are a lot of hypotheses about what’s causing it. It remains unknown.”

When biologic drugs were studied in randomized trials and became an option to treat patients with sJIA, they helped improve the outcome of a lot of children, Dr. Cron noted. In particular, biologic agents that block interleukin 1 (IL-1) and interleukin-6 (IL-6) have made a big difference in the lives of many with the disease over a span of about two decades.

“It was a game-changer for these children,” he said. “It completely changed their lives, so they weren’t steroid-dependent. They weren’t in the hospital all the time. They weren’t suffering macrophage activation syndrome.”

An apparent downside to the success of these biologics surfaced in about 2013 after data showed that a small percentage of children treated with them developed lung disease as part of their sJIA, Dr. Cron said. Opposition to the use of IL-1 and IL-6 inhibitors to treat this pediatric population continued when more data from clinical trials emerged.

The topic is important to patients because of the possibility of serious health issues, including death of a child.

“There are arguments both ways. First, do no harm,” Dr. Cron noted. “On the other hand, if you’re not treating the kids, that’s harmful too. So, it’s complicated.”

Because questions remain about biologics’ safety in the treatment of children with sJIA, the topic is ripe for debate, Dr. Onel noted.

“All of us have very strong opinions about it,” she said. “This gives us an opportunity to review the literature and explain to each other why we think the way that we do about those questions.”