Tofacitinib for treating juvenile idiopathic arthritis

1.1 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:

1.2 Tofacitinib can be used with methotrexate, or as monotherapy when methotrexate is not tolerated or if continued treatment with methotrexate is inappropriate.

1.3 If tofacitinib is one of a range of treatments considered suitable by patients, or their parents or carers, and their clinicians, choose the least expensive (taking into account administration costs and commercial arrangements).

1.4 This recommendation is not intended to affect treatment with tofacitinib that was started in the NHS before this guidance was published. Children and young people having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. This decision should be made jointly by the clinician, the child or young person, and their parents or carers.

Why the committee made these recommendations

Treatments for JIA that has not responded well enough to DMARDs include adalimumab, etanercept and tocilizumab.

Clinical trial evidence shows that tofacitinib is effective compared with placebo. There are no trials directly comparing tofacitinib with current treatments. But an indirect comparison suggests that tofacitinib has similar effects to adalimumab and tocilizumab. There is no evidence for tofacitinib compared with etanercept.

Tofacitinib has similar costs to tocilizumab. But it costs more than adalimumab and is likely to cost more than etanercept.

Most people with the 2 kinds of JIA being considered have adalimumab or etanercept, which are TNF-alpha inhibitors. So tofacitinib is only recommended when a TNF-alpha inhibitor is unsuitable or has not worked well enough.