Abatacept, adalimumab, etanercept and tocilizumab are recommended, within their marketing authorisations, as options for treating polyarticular juvenile idiopathic arthritis (JIA), including polyarticular-onset, polyarticular-course and extended oligoarticular JIA.
NICE technology appraisal TA373
Adalimumab and etanercept can now be used to treat enthesitis-related JIA in children 6 years of age and older (adalimumab) and over 12 years old (etanercept), when the response to conventional therapy is inadequate or not tolerated.
Similarly, etanercept can be used to treat psoriatic JIA in children 12 years of age and above whose disease has responded inadequately to, or who are intolerant of, methotrexate.
When more than one drug is suitable, treatment should be started with the least expensive drug, taking into account administration costs, the dose required and the cost per dose.
NHS approval for abatacept and tocilizumab was granted on the basis that the drug is supplied by the manufacturer with the discount agreed in the patient access scheme.
This recommendation replaces previous guidance issued by NICE on the use of etanercept for the treatment of JIA.