Effectiveness and Safety of High-Dose Biologics in Juvenile Idiopathic Arthritis in the Childhood Arthritis and Rheumatology Research Alliance

Arthritis Care Res (Hoboken). 2022 Nov;74(11):1770-1779. doi: 10.1002/acr.24727. Epub 2022 Jul 31.


Objective: To describe high-dose biologic use when treating juvenile idiopathic arthritis (JIA).

Methods: Patients with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry and treated with a biologic after enrollment were eligible. We described the frequency of high-dose biologic use and characteristics of patients receiving high-dose biologics. We used regression modeling to compare 6-month outcomes (using disease activity measures) between those who increased their biologic from standard to high dose (high-dose group) to those who initiated and remained on standard dosing (no-change group), and to those who switched biologic agents (biologic-switch group). We also compared serious adverse events (SAEs) between groups.

Results: A total of 5,352 patients with JIA were treated with biologics following enrollment; 1,080 (20%) had ever received a high-dose biologic. There were no significant differences in outcomes between the high-dose group and the biologic-switch group; both improved disease activity measures, including the clinical Juvenile Arthritis Disease Activity Score 10 (-3.53 and -3.95, respectively; P = 0.68). Although the SAE rates in the high-dose group and the biologic-switch group were numerically higher than the no-change group, the event rates were similar, and neither rate was significantly higher than in the no-change group (unadjusted incident rate ratio 2.5 [95% confidence interval (95% CI) 0.7-8.5] and 1.8 [95% CI 0.7-4.6], respectively).

Conclusion: Dosing escalation appears to be a reasonable choice to improve disease control, but large, prospective, randomized studies evaluating specific biologic agents are needed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antirheumatic Agents* / adverse effects
  • Arthritis, Juvenile* / diagnosis
  • Arthritis, Juvenile* / drug therapy
  • Biological Factors / therapeutic use
  • Biological Products* / adverse effects
  • Child
  • Humans
  • Prospective Studies
  • Registries
  • Rheumatology*
  • Treatment Outcome


  • Antirheumatic Agents
  • Biological Products
  • Biological Factors