THE TREATMENT landscape for juvenile idiopathic arthritis (JIA) has shifted significantly over the past two decades, according to a new study analyzing DMARD (disease-modifying antirheumatic drug) utilization among commercially insured children in the United States from 2001 to 2022.
Researchers evaluated 20,258 new DMARD use episodes in 13,696 children with JIA, with a median age of 14 years and 67.5% female. While conventional synthetic (csDMARD) therapies such as methotrexate initially dominated treatment, their use has declined sharply, dropping from 89.5% of new DMARD initiations in 2001 to just 43.2% in 2022 (p<0.001). In contrast, the use of biologic (bDMARD) and targeted synthetic (tsDMARD) therapies has surged, now representing half of all new treatment episodes. Adalimumab, a tumor necrosis factor inhibitor (TNFi), has emerged as a leading option. Its use doubled shortly after its JIA approval in 2007 and saw further gains following the release of a less painful formulation, reaching 20.5% of new DMARD initiations in 2022. Among b/tsDMARDs initiated after csDMARD monotherapy, adalimumab accounted for 77.8% of first-line use by 2022. Other newer b/tsDMARDs, including ustekinumab, secukinumab, and tofacitinib, are also contributing to the decline of TNFi dominance, signaling broader shifts in therapeutic preferences influenced by regulatory approvals and patient tolerability. This evolving pattern underscores the dynamic nature of JIA treatment, reflecting advances in medication options and a growing emphasis on individualized care. Reference: Yalamanchili P et al. Trends in new use of disease-modifying antirheumatic drugs in juvenile idiopathic arthritis among commercially insured children in the United States from 2001-2022. Arthritis Rheumatol. 2024. https://doi.org/10.1002/art.43041.
