Emerging treatments

Baricitinib

Baricitinib is a Janus kinase (JAK) inhibitor. It is approved for the treatment of juvenile idiopathic arthritis by the European Medicines Agency (EMA), in children 2 years and older who have had an inadequate response or intolerance to one or more prior conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs).[115]​ It may be used as monotherapy or in combination with methotrexate. Baricitinib is not currently approved in the US for this indication. Further guidance on its use is expected by late 2023.

Tofacitinib

Tofacitinib is another JAK inhibitor. One phase 3 study has demonstrated that tofacitinib significantly reduces disease flares in patients with polyarticular JIA, compared with placebo.[116] Tofacitinib is approved in the US and Europe for use in children aged 2 years and older with active polyarticular JIA.

Golimumab

Golimumab is a recombinant human monoclonal antibody against tumour necrosis factor alpha.[117] In Europe, it is indicated for the treatment of polyarticular juvenile idiopathic arthritis in children in combination with methotrexate. It has been approved by the US Food and Drug Administration for children aged 2 years and older with polyarticular JIA.

Rilonacept

An interleukin-1 inhibitor that has demonstrated efficacy in active systemic JIA.[118] In one small study, rilonacept was shown to be well tolerated and demonstrated improvements in articular and systemic manifestations of JIA in >50% of patients over 2 years.[108]

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