Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease, and disease-modifying anti-rheumatic drugs (DMARDs) are the most effective treatments for JIA and JIA-associated uveitis. These treatments include conventional synthetic DMARDs, such as methotrexate; biologic DMARDs, such as etanercept, adalimumab and tocilizumab; and targeted synthetic DMARDs, such as tofacitinib and baricitinib.
In an effort to identify and describe trends in prescribing practices for pediatric patients with JIA, Yalamanchili et al. evaluated the use of DMARDs over the past two decades among commercially insured children with JIA aged 1 to 18 years.
Methods
This serial, cross-sectional utilization study examined patient data from 2000 to 2022. The researchers identified initiations of conventional synthetic DMARDs, biologic DMARDs and targeted synthetic DMARDs after a ≥12-month baseline. These data were expressed as a percentage of all new DMARD initiations per year, by category, class and agent. Trends were evaluated using linear regression.
They also examined the first biologic DMARDs and targeted synthetic DMARDs initiated after conventional synthetic DMARD monotherapy.
The Results
The study identified 20,258 episodes of new DMARD use among 13,696 patients with a median age 14 years (67.5% female).
Although conventional synthetic DMARDs were the most used treatment overall, their use declined from 89.5% of new use episodes to 43.2% over the study period (P<0.001 for trend). Meanwhile, biologic DMARD use increased (10.5–50%, P<0.001) over the study period.
Data on tumor necrosis factor (TNF) inhibitors showed that the new use of etanercept peaked at 28.3% in 2006 and declined to 4.2% in 2022 (P=0.002). Adalimumab use doubled (7–14% from 2007–2008) after its approval as a JIA treatment. It’s use continued to increase after a less painful formulation was released (20.5% in 2022, P<0.001). Overall, the study showed that TNF inhibitor use has declined.
Additionally, study data showed an increase in the use of other biologic DMARDs and targeted synthetic DMARDs, particularly ustekinumab, secukinumab and tofacitinib. In 2022, adalimumab was the most common first-initiated, biologic/targeted synthetic DMARD in patients after trying a conventional synthetic DMARD (77.8%).
Conclusion
For commercially insured patient in the U.S., patterns in new DMARD use for JIA have evolved due to multiple factors, including regulatory approvals and tolerability. Overall, the study demonstrated that from 2000 to 2022 in this patient population the use of biologic and targeted synthetic DMARDs has risen and the use of conventional synthetic DMARDs has declined.
For complete details, including source material, refer to the full study.
Excerpted and adapted from:
Yalamanchili P, Lee LY, Bushnell G, et al. Trends in new use of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis among commercially insured children in the United States from 2001 to 2022. Arthritis Rheumatol. 2025 Apr;77(4):468–476.
