NICE guidance - Tofacitinib for treating juvenile idiopathic arthritis
Last edited 10/2021 and last reviewed 11/2021
NICE state (1):
Tofacitinib is recommended as an option for treating active polyarticular juvenile idiopathic arthritis (JIA; rheumatoid factor positive or negative polyarthritis and extended oligoarthritis), and juvenile psoriatic arthritis in people 2 years and older. This is if their condition has responded inadequately to previous treatment with disease-modifying antirheumatic drugs (DMARDs), and only if:
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a tumour necrosis factor (TNF)-alpha inhibitor is not suitable or does not control the condition well enough, and
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the company provides tofacitinib according to the commercial arrangement
Tofacitinib can be used with methotrexate, or as monotherapy when methotrexate is not tolerated or if continued treatment with methotrexate is inappropriate
Notes:
- tofacitinib is an oral Janus kinase inhibitor (1,2,3) - is an IL-6 inhibitor approved for polyarticular and systemic JIA (3)
- JAK signaling is critical for the signal transduction of multipleinflammatory cytokines
- the 4 members of the Jak family, Jak1, Jak2, Jak3, and tyrosine kinase 2 (Tyk2), serve a critical function in immune cell activation, proinflammatory cytokine production, and cytokine signaling
- evidence suggests, in a open-label Phase 1 study in pediatric patients with polyarticular JIA, that Tofacitinib was well tolerated and the taste was acceptable (2)
- JAK signaling is critical for the signal transduction of multipleinflammatory cytokines
Reference:
- NICE (October 20th 2021). Tofacitinib for treating juvenile idiopathic arthritis
- Ruperto N, Brunner HI, Zuber Z, et al. Pharmacokinetic and safety profile of tofacitinib in children with polyarticular course juvenile idiopathic arthritis: results of a phase 1, open-label, multicenter study. Pediatr Rheumatol Online J. 2017;15(1):86. Published 2017 Dec 28. doi:10.1186/s12969-017-0212-y
- Bridges JM, Mellins ED, Cron RQ. Recent progress in the treatment of non-systemic juvenile idiopathic arthritis. Fac Rev. 2021;10:23. Published 2021 Feb 26. doi:10.12703/r/10-23