Early intensification versus step-up biologic strategies in systemic juvenile idiopathic arthritis: a Bayesian network meta-analysis of remission and safety outcomes
Authors' conclusion
In sJIA, immediate intensive IL-1/IL-6 therapy at diagnosis is more effective than a step-up approach in achieving and maintaining CID/remission, while also having an acceptable safety profile, supporting the initial "target-to-treat (T2T)" strategy.
Study context
- Population
- Patients with Systemic Juvenile Idiopathic Arthritis (sJIA); databases searched from inception to October 2025
- Participants
- 1,548 patients15 studies
- Comparison
- Early IL-1/IL-6 blockade vs step-up biologic strategies, anakinra, canakinumab, tocilizumab, conventional care and mixed biologic strategies
- Outcome
- CID/remission rate
Methodological detailsRandomized controlled trials (RCTs), prospective cohorts and retrospective/registry studies, random-effects and Bayesian hierarchical network models, PRISMA 2020 and PRISMA-NMA, ROB-2, NOS and GRADE
- RCTs, prospective cohorts and retrospective/registry studies
- Random-effects and Bayesian hierarchical network models
- PRISMA 2020 and PRISMA-NMA
- ROB-2, NOS and GRADE
Pooled result
As reported in the abstract
CID/remission · during follow-up
- Approximately two-thirds of patients achieved CID/remission during follow-up (pooled, random-effects model)
- Early IL-1/IL-6 strategy had a more favorable response rate (stratification)
- SUCRA ranking: early IL-1/IL-6 blockade first, followed by anakinra and canakinumab; tocilizumab in the middle; conventional care and mixed biologic strategies last
Safety
Adverse events (AEs) (normalized per patient-year)
- Overall AE rate low and consistent across studies; IL-1/IL-6 targeted drugs had a favorable safety profile
Original publication
Early intensification versus step-up biologic strategies in systemic juvenile idiopathic arthritis: a Bayesian network meta-analysis of remission and safety outcomes. Pediatr Rheumatol Online J. Published 25 May 2026. doi:10.
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