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Changes in systemic medication in children and adolescents with JIA: why, when and which patterns
Merel Boer-de Boer1, Sytze de Roock2,3, Antoine C G Egberts1,4
1Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
Rheumatology (Oxford, England)
|June 11, 2026
Summary
Juvenile idiopathic arthritis (JIA) medication changes often occur due to inefficacy with methotrexate initially, but remission is achieved more frequently with biological disease-modifying antirheumatic drugs (bDMARDs) in later treatment lines.
Area of Science:
- Pediatric Rheumatology
- Clinical Pharmacology
- Drug Efficacy Studies
Background:
- Juvenile idiopathic arthritis (JIA) management involves complex systemic medication adjustments.
- Understanding treatment patterns and reasons for change is crucial for optimizing patient outcomes.
Purpose of the Study:
- To analyze the patterns, timing, and reasons for systemic medication changes in JIA patients.
- To evaluate the effectiveness of different treatment lines in JIA management.
Main Methods:
- Prospective cohort study of JIA patients initiating first-line systemic therapy.
- Construction of treatment lines for systemic corticosteroids, conventional (cDMARDs), and biological (bDMARDs) disease-modifying antirheumatic drugs.
- Analysis of change reasons using Sankey diagrams and Fine-Gray models.
Main Results:
- 551 JIA patients were analyzed, with oligoarticular JIA being the most common diagnosis.
- Methotrexate was the primary first-line treatment (89.1%), followed by bDMARDs in subsequent lines (53.3%).
- Treatment changes were most often due to inefficacy in the first line (42.9%) and remission in the second line (46.2%).
Conclusions:
- JIA medication adjustments are frequently driven by inefficacy early in treatment, particularly with methotrexate.
- Remission rates are higher in the second treatment line, often involving bDMARDs, suggesting their superior efficacy in a subset of JIA patients.
- Findings advocate for reconsidering current JIA treatment guidelines to potentially incorporate bDMARDs earlier or more broadly.
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