E062 Real-world experience of tofacitinib as treatment for juvenile idiopathic arthritis

Abstract

Background/Aims In October 2021, the National Institute for Health and Care Excellence (NICE) recommended tofacitinib to treat polyarticular juvenile idiopathic arthritis (JIA) and juvenile psoriatic arthritis in cases resistant to at least one DMARD and for whom a TNFα inhibitor is not suitable or does not control disease adequately. This study aimed to assess the effectiveness of tofacitinib in treating resistant JIA, and identify any trends linked to treatment success or failure. Methods The project was registered as an audit and service evaluation. Patients (≤ 18 years with JIA, who received tofacitinib between October 2021 and June 2024 with ≥ 3 months follow-up) were identified by the Paediatric Rheumatology Pharmacist. Data were collected retrospectively from electronic patient records. These included patient demographics, previous and concomitant medications, active joint count and inflammatory markers at baseline and 3-monthly follow-up. Results Seven patients (3 female) were included with a median age at diagnosis of 7 years (range: 1-13 years). Median disease duration before starting tofacitinib was 3.6 years (range: 1.1-13.2 years). The oral route was a factor in choosing tofacitinib in two patients with needle anxiety. Demographic and follow-up data are shown in Table 1. Of 4 patients with active joints at baseline only 2 had a decrease in active joint count by 12 weeks. Three patients with extended oligoarthritis continued tofacitinib successfully, suggesting a possible link between this category and treatment success. However, two of these had no active arthritis a baseline which may be a factor. All patients who stopped tofacitinib did so due to a flare of arthritis rather than side effects. One patient developed new uveitis while on tofacitinib. No association was found between treatment success and gender, ANA status, or previous history of uveitis. Disease duration before starting tofacitinib also appeared to have no effect on outcomes. Conclusion Although the small sample size limits the ability to draw definitive conclusions, some initial trends suggest that tofacitinib is effective in controlling extended oligoarthritis. It appears to be partially effective in psoriatic and RF-negative polyarticular JIA initially but did not achieve complete remission. The side effect profile seems tolerable. Disclosure A. Vahed: None. K. Hartley: None. S. Jandial: None. F. McErlane: None. S. Sampath: None. E.S. Sen: None.