Infections in Children and Adolescents With Juvenile Idiopathic Arthritis and Inflammatory Bowel Disease Treated With Tumor Necrosis Factor–α Inhibitors: Systematic Review of the Literature

Tumor necrosis factor alpha (TNF-α) inhibitors are increasingly being administered to children and adolescents with juvenile idiopathic arthritis (JIA) or pediatric inflammatory bowel disease (pIBD). Adult studies have, for the most part, shown that TNF-α inhibitors lead to an increased risk of opportunistic infections, serious infections, and hospitalizations, when compared to other disease-modifying antirheumatic drugs (DMARDs) [1–4]. Despite the extensive use of biologics in pediatrics, it remains unclear whether there is a similarly increased risk of infections and what types of infections occur. To date, studies in children with JIA or pIBD treated with TNF-α antagonists have consisted of small numbers of subjects, with outcomes mostly focused on drug efficacy and serious adverse events. Furthermore, strategies to prevent infections and safely monitor pediatric patients treated with TNF-α inhibitors are largely extrapolated from the adult literature. This systematic literature review describes the 3 main TNF-α inhibitors used in JIA or pIBD, summarizes the microbiology and types of infections pediatric patients treated with TNF-α inhibitors may be susceptible to, and provides an overview of strategies that may be useful for the prevention of infectious complications in this population. Characterizing the infections that occur in JIA and pIBD patients treated with TNF-α inhibitors may help prevent unnecessary treatment interruptions and unwarranted hospitalizations.