We welcome the trial data for tofacitinib as a drug that might provide benefit for children and young people with juvenile idiopathic arthritis. We are encouraged by the findings, particularly the safety data, but seek clarification on the clinical efficacy. Nicolino Ruperto and colleagues state that stable doses of glucocorticoids were permitted (0-2 mg/kg per day or 10 mg of prednisolone equivalent per day, whichever is lower, for at least 2 weeks before baseline). 2 weeks is a comparatively short lead in time and could influence the response rate in part one of the trial. Could the higher rates of glucocorticoids in the treatment group in part two (39% vs 26%, median dose 5 mg per day) also affect the reported flare and response rates? This difference in rates of glucocorticoid use is clinically relevant and worth highlighting. Long-term low-dose glucocorticoids are useful for maintaining disease control and reducing risk of flare in similar conditions, such as rheumatoid arthritis, lupus, and vasculitis. Were supplementary analyses done to address this potential confounding factor? Could the authors also clarify how many patients received intraarticular steroid injections because this is also important in considering overall steroid exposure.
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