Combination targeted therapy with Janus kinase inhibition plus biologic agents in refractory juvenile idiopathic arthritis (JIA): an international multi-centre case series
Authors' conclusion
JAKi-biologic CTT may have a role in improving disease control in refractory JIA, enabling some reduction in glucocorticoids, with no serious infections reported.
Study context
- Population
- Patients with refractory juvenile idiopathic arthritis (JIA) treated with combination targeted therapy (CTT) using a Janus kinase inhibitor (JAKi) and biologic, paediatric rheumatology centres across the United Kingdom and Republic of Irelandpatients with JIA (11 Still’s disease/systemic, 1 psoriatic, 1 extended oligoarticular) across nine centres
- Participants
- 13 patients
- Outcome
- Intravenous methylprednisolone exposure, 12 months before vs 12 months on CTT (paired analysis, 11/13 remaining on CTT ≥12 months)
- Follow-up
- 12 months
Methodological detailsretrospective review of medical records, paired data analysed using Wilcoxon signed-rank test
- Retrospective review of medical records
- Paired data analysed using Wilcoxon signed-rank test
Main finding
As reported in the abstract
- Significant reduction in 12-month intravenous methylprednisolone exposure, median 109mg/kg vs. 0mg/kg
- p=0.013
Observational data: associations, not effects.
Further findings
Active joint count (paired analysis) · 12 months
- Significant reduction in active joint count, median 5 vs. 2 joints
- P = 0.009
- Wilcoxon signed-rank test
Inactive disease among those still on CTT · last follow-up (median 21.5 months)
- Inactive disease, of those still on CTT
- 6/10
Off systemic steroids among those still on CTT · last follow-up (median 21.5 months)
- Off systemic steroids, of those still on CTT
- 8/10
Baseline characteristics and treatment history
- Historical joint damage
- 39%
- Glucocorticoid toxicity
- 77%
- Conventional/biologic/targeted synthetic DMARDs before CTT, median (IQR)
- 5 (4-7)
- Duration of prior treatment before CTT, median months (IQR)
- 66 (36-133)
- Age at CTT initiation, median years (IQR)
- 12 (9-14)
- Tofacitinib-tocilizumab was the most frequent combination
CTT use
- CTT used briefly as bridging therapy
- 2/13
- Remaining on CTT for ≥12 months
- 11/13
Safety
Serious infections
- No serious infections occurred
Non-infectious serious adverse events
- Non-infectious serious adverse events (hip avascular necrosis and pulmonary alveolar proteinosis)
- Two
Original publication
Combination targeted therapy with Janus kinase inhibition plus biologic agents in refractory JIA: an international multi-centre case series. Rheumatology (Oxford). Published 12 November 2026. doi:10.
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