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Southampton Health Technology Assessments CentreNews

Biologic drug therapies for the treatment of juvenile idiopathic arthritis - NICE guidance now available

Published: 17 December 2015
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis causes pain, stiffness and swelling of the affected joints

The National Institute for Health and Care Excellence (NICE) has issued guidance to the health service on the use of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis (JIA), informed by a report produced by SHTAC.

JIA is an inflammation of the joints that begins in people under 16 years of age where the cause or trigger is uncertain or unknown. JIA lasts for at least six weeks and causes pain, stiffness and swelling of the affected joints.

There are several different forms of JIA, characterised by the number of affected joints or associated features. NICE’s appraisal included extended oligoarticular JIA (at the start 4 or fewer joints are affected, by after 6 months or longer 5 or more joints become affected); polyarticular JIA (5 or more joints are affected); enthesitis-related JIA (the arthritis is associated with swelling of tendons at the point of insertion into bones, these insertion points are called enthesitis); and psoriatic JIA (associated with psoriasis which is a flaky skin condition).

Treatment typically follows a stepped approach that begins with a non-steroidal anti-inflammatory drug, followed by corticosteroids, and disease modifying anti-rheumatic drugs (DMARD) such as methotrexate. If an adequate response is not achieved with methotrexate one of several biologic DMARDs may be offered.

NICE’s guidance is that the biologic DMARDs abatacept (Orencia®), adalimumab (Humira®), etanercept (Enbrel®) and tocilizumab (RoActemra®) are recommended as possible treatments for people with polyarticular JIA. Adalimumab and etanercept are also recommended as possible treatments for people with enthesitis-related JIA. Etanercept is recommended as a possible treatment for people with psoriatic JIA.

NICE’s guidance is informed by an assessment report prepared by SHTAC, which will also be available as a health technology assessment monograph in the National Institute for Health Research (NIHR) Journals Library in early 2016.

This guidance replaces the previous NICE technology appraisal guidance on the use of etanercept for the treatment of juvenile idiopathic arthritis (TA35). Separate NICE guidance is also available for tocilizumab for the treatment of systemic JIA.

For more information on SHTAC's research into bone and joint diseases please visit our Research page.

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