为了描述美国青少年特发性关节炎 (JIA) 儿童使用 DMARD 的最新趋势。我们使用商业索赔数据 (2000-2022) 对 1-18 岁诊断为 JIA 的儿童进行了一系列横断面利用研究。常规合成 (cs)、生物 (b) 或靶向合成 (ts) DMARD 的启动在 ≥12 个月的基线后确定，并表示为每年所有新 DMARD 启动的百分比（按类别、类别和个体药物）。使用线性回归评估趋势。其次，我们检查了 csDMARD 单药治疗后启动的第一个 b/tsDMARD。我们在 13,696 名个体（中位年龄 14 岁，67.5% 女性）中发现了 20,258 次新的 DMARD 使用事件。 csDMARD 虽然总体上最常用，但从新使用事件的 89.5% 下降到 43.2%（2001-2022 年，趋势 p<0.001）。相比之下，bDMARD 使用量增加（10.5-50.0%，p<0.001）。对于肿瘤坏死因子抑制剂 (TNFi)，依那西普的峰值达到 28.3% (2006 年)，并下降至 4.2% (2022 年) (p=0.002)。与此同时，在 JIA 批准后，阿达木单抗的使用量增加了一倍（7.0-14.0%，2007-2008 年），并在减轻痛苦的制剂发布后进一步增加（20.5%，2022 年，p<0.001）。然而，随着其他 b/tsDMARD（特别是乌特克单抗、苏金单抗和托法替尼）使用的增加，TNFi 的总体使用量有所下降。到 2022 年，阿达木单抗是继 csDMARD 之后最常见的 b/tsDMARD（77.8%）。在美国商业保险的 JIA 儿童中，新的 b/tsDMARD 使用量正在上升，而新的 csDMARD 使用量正在下降。对于 b/tsDMARD，阿达木单抗使用最多，并且主要的 b/tsDMARD 在 csDMARD 之后首先启动。 JIA 的 DMARD 使用模式已随着多种因素的发展而演变，包括监管批准和耐受性。本文受版权保护。版权所有。

To describe recent trends in DMARD use for children with juvenile idiopathic arthritis (JIA) in the US.We used commercial claims data (2000-2022) to perform a serial cross-sectional utilization study of children ages 1-18 diagnosed with JIA. Initiations of conventional synthetic (cs), biologic (b), or targeted synthetic (ts) DMARDs were identified after a ≥12-month baseline and expressed as percentage of all new DMARD initiations per year, by category, class, and individual agent. Trends were evaluated using linear regression. Secondarily, we examined first b/tsDMARDs initiated after csDMARD monotherapy.We identified 20,258 new DMARD use episodes among 13,696 individuals (median age 14 years, 67.5% female). csDMARDs, while most commonly used overall, declined from 89.5% of new use episodes to 43.2% (2001-2022, p<0.001 for trend). In contrast, bDMARD use increased (10.5-50.0%, p<0.001). For tumor necrosis factor inhibitors (TNFi), etanercept peaked at 28.3% (2006) and declined to 4.2% (2022) (p=0.002). Meanwhile, adalimumab use doubled (7.0-14.0%, 2007-2008) after JIA approval, increasing further following a less painful formulation release (20.5%, 2022, p<0.001). However, overall TNFi use has declined with increasing use of other b/tsDMARDs, particularly ustekinumab, secukinumab, and tofacitinib. By 2022, adalimumab was the most common b/tsDMARD initiated first after csDMARDs (77.8%).Among commercially insured children with JIA in the US, new b/tsDMARD use is rising while new csDMARD use declines. For b/tsDMARDs, adalimumab is most used and the predominant b/tsDMARD initiated first after csDMARDs. Patterns in DMARD use for JIA have evolved relative to multiple factors, including regulatory approvals and tolerability.This article is protected by copyright. All rights reserved.