Inactive disease a viable target in tofacitinib-treated patients with JIA

Treatment with tofacitinib improves the rates of Juvenile Arthritis Disease Activity Score (JADAS) in 10 joints (JADAS10)-clinically inactive disease (CID) and American College of Rheumatology (ACR)-CID in patients with juvenile idiopathic arthritis (JIA), with improvements sustained over time, a study has shown. Additionally, a few patients have achieved JADAS10 remission.

“Taken together, these results suggest that CID and remission are feasible treatment targets in patients receiving tofacitinib,” the researchers said.

Patients with active JIA (polyarticular-course JIA, psoriatic arthritis, or enthesitis-related arthritis) enrolled in a phase III randomized withdrawal study of tofacitinib were included in this post hoc analysis.

Participants received open-label tofacitinib in part 1 (weeks 0‒18), and those who achieved ACR improvement ≥30 percent were randomized to tofacitinib or placebo for 25 weeks or until JIA flare in part 2 (weeks 18‒44).

The researchers assessed disease activity using JADAS10 based on C-reactive protein, with interpretation according to 2021 polyarthritis thresholds. JADAS10 remission was characterized by ≥24 continuous weeks of JADAS10-CID. The research team also assessed ACR-CID and ACR clinical remission.

Of the 225 patients with JIA included in part 1, 173 (76.9 percent) were randomized in part 2 to continue treatment with tofacitinib or switch to placebo. [J Rheumatol 2025;52:919-926]

Throughout part 1, the rate of JADAS10-CID increased to 30.5 percent, while that of ACR-CID rose to 15.8 percent at week 18. These improvements were sustained with tofacitinib throughout part 2 (week 44: 35.2 percent for JADAS10-CID and 25 percent for ACR-CID) and decreased when patients switched to placebo (weeks 44: 25.9 percent for JADAS10-CID and 15.3 percent for ACR-CID).

Notably, a small proportion of patients with JIA attained JADAS10 remission at week 44 (14.8 percent with tofacitinib vs 7.1 percent with placebo).

“The efficacy results presented here will further inform clinical decision making in regard to tofacitinib as an oral treatment option for patients with JIA,” the researchers said.

Remission

The rates of JADAS10-CID and remission were consistently higher in the tofacitinib group than the placebo group throughout part 2, which is in line with expectations. However, JADAS10 remission rates were relatively low, but this may have been influenced by the short study duration and the sustained symptom control required.

“These findings suggest that JADAS10-CID is a feasible treatment target for patients with JIA treated with tofacitinib,” the researchers said.

When compared with ACR0CID, the rates of JADAS10-CID were also higher due to the stricter ACR criteria, with patients having to achieve additional criteria, according to the researchers.

“Moreover, whereas rates of JADAS10-CID were maintained throughout part 2, rates of ACR-CID continued to steadily increase up to 25 percent in the group receiving tofacitinib at week 44,” they said.

The ACR-CID rates in the current study are similar to those of an earlier study of JIA patients treated with double-blind treatment with abatacept. [Lancet 2008;372:383-391]

“Interestingly, rates of CID in our analysis were lower than in studies of patients receiving etanercept or open-label treatment with golimumab,” the researchers said. [J Rheumatol 2013;40:192-200; Ann Rheum Dis 2018;77:21-29]

“This may be accounted for by the age at disease onset; the study of etanercept found that children (median age 3.6 years) with disease onset before 3.6 years of age had a greater likelihood of achieving ACR-CID. By comparison, patients in our analysis were older at disease onset (median age 8 years),” they added.