Abatacept, Adalimumab, Etanercept and Tocilizumab for Treating Juvenile Idiopathic Arthritis (TA373)

Technology Appraisal Guidance No. 373

Source: National Institute for Health and Care Excellence

NOTE: This guidance replaces ‘NICE technology appraisal guidance 35’ issued in March 2002.

1. Guidance

1.1 Abatacept, adalimumab, etanercept and tocilizumab are recommended as options for treating polyarticular juvenile idiopathic arthritis (JIA), including polyarticular-onset, polyarticular-course and extended oligoarticular JIA. That is:

  • for abatacept, people 6 years and older whose disease has responded inadequately to other disease-modifying anti-rheumatic drugs (DMARDs) including at least 1 tumour necrosis factor (TNF) inhibitor
  • for adalimumab, people 2 years and older whose disease has responded inadequately to 1 or more DMARD
  • for etanercept, people 2 years and older whose disease has responded inadequately to, or who are intolerant of, methotrexate
  • for tocilizumab, people 2 years and older whose disease has responded inadequately to previous therapy with methotrexate.

    Abatacept and tocilizumab are recommended only if the companies provide them with the discounts agreed in the patient access schemes for these technologies.

1.2 Adalimumab and etanercept are recommended as options for treating enthesitis-related JIA, that is, for people 6 years and older (adalimumab) and 12 years and older (etanercept) whose disease has responded inadequately to, or who are intolerant of, conventional therapy.

1.3 Etanercept is recommended as an option for treating psoriatic JIA, that is, in people aged 12 years and over whose disease has responded inadequately to, or who are intolerant of, methotrexate.

1.4 When more than 1 technology is suitable (taking into account extra-articular manifestations) treatment should be started with the least expensive technology, taking into account administration costs, the dose needed and the product cost per dose.


The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at http://guidance.nice.org.uk/TA373

This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

© Copyright National Institute for Health and Care Excellence. All rights reserved. This material may be freely reproduced for educational and not for profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.

Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email: nice@nice.org.uk

Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

Issue Date: December 2015


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