Greater access to JAK inhibitors is needed for rheumatic diseases in children

The Canadian Rheumatology Association (CRA) has issued a position statement advocating for greater access to JAK inhibitors (tofacitinib, baricitinib, upadacitinib) for children and adolescents in Canada. They contend that JAK inhibitors are effective treatments for several rheumatic conditions, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and juvenile idiopathic arthritis. They note that a placebo-controlled, withdrawal phase 3 randomized trial in pediatric patients with juvenile idiopathic arthritis demonstrated a significantly lower flare rate in children receiving tofacitinib versus placebo. In addition, the benefit of tofacitinib in juvenile idiopathic arthritis is sustained over time and may lead to clinical remission. The CRA points out that similar beneficial results have been seen in early trials with baricitinib and upadacitinib. The CRA believes that JAK inhibitors are effective and safe for the treatment of juvenile idiopathic arthritis and have the advantage of being orally administered medications. Other advanced therapeutic drug classes used for juvenile idiopathic arthritis must be administered by subcutaneous injection or intravenous infusion. Injectables can have a negative impact on children and adolescents due to potential trauma and pain, leading to harmful effects on mental health and quality of life.Currently, Health Canada has approved three oral JAK inhibitors for multiple rheumatic conditions in adults (≥ 18 years of age). Only one oral JAK inhibitor (tofacitinib) has been approved for the treatment of polyarticular juvenile idiopathic arthritis in children weighing > 40 kg, and no public or private reimbursement for this medication is currently available for children in Canada. In addition, no JAK inhibitors in oral solid or suspension dosage forms are yet approved in Canada for younger patients (< 40 kg), a group that would benefit most from these oral medications. As a result, the CRA maintains that children in Canada with juvenile idiopathic arthritis currently have very limited access to JAK inhibitors, a critical class of effective oral advanced therapeutics that can be used in combination with conventional disease modifying anti-rheumatic drugs (DMARDs) or for disease refractory to biological DMARDs. The CRA has identified this gap in therapeutic care as a key priority for the pediatric rheumatology population in Canada. The CRA advocates for equity in the treatment of juvenile idiopathic arthritis in children in Canada.Reference:Canadian Rheumatology Association. Position statement for access to JAK inhibitors for children in Canada. November 25, 2025. (accessed December 22, 2025).

Greater access to JAK inhibitors is needed for rheumatic diseases in children

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