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

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. 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.

Adalimumab and etanercept are recommended, within their marketing authorisations, 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.

Etanercept is recommended, within its marketing authorisation, 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.

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.