BACKGROUND: Treatment of juvenile idiopathic arthritis (JIA) with 
disease-modifying antirheumatic drugs (DMARDs) may improve outcomes compared to 
conventional therapy (e.g., non-steroidal anti-inflammatory drugs, 
intra-articular corticosteroids). The purpose of this systematic review was to 
evaluate the comparative effectiveness and safety of DMARDs versus conventional 
therapy and versus other DMARDs.
RESULTS: A systematic evidence review of 156 reports identified in MEDLINE®, 
EMBASE®, and by hand searches. There is some evidence that methotrexate is 
superior to conventional therapy. Among children who have responded to a 
biologic DMARD, randomized discontinuation trials suggest that continued 
treatment decreases the risk of having a flare. However, these studies evaluated 
DMARDs with different mechanisms of action (abatacept, adalimumab, anakinra, 
etanercept, intravenous immunoglobulin, tocilizumab) and used varying 
comparators and follow-up periods. Rates of serious adverse events are similar 
between DMARDs and placebo in published trials. This review identified 11 
incident cases of cancer among several thousand children treated with one or 
more DMARD.
CONCLUSIONS: Few data are available to evaluate the comparative effectiveness of 
either specific DMARDs or general classes of DMARDs. However, based on the 
overall number, quality, and consistency of studies, there is moderate strength 
of evidence to support that DMARDs improve JIA-associated symptoms. Limited data 
suggest that short-term risk of cancer is low.