ModifiedUnitedHealthcarePolicy CS2026D0039AD

Orencia (abatacept) Injection for Intravenous Infusion — Medical Benefit Drug Policy

Medical benefit policy governing intravenous Orencia (abatacept) infusion for specified indications; affects providers prescribing or administering IV abatacept under UnitedHealthcare commercial medical benefit. Subcutaneous Orencia is covered under the pharmacy benefit and not governed here.

Policy Summary

PayerUnitedHealthcare

PolicyOrencia (abatacept) Injection for Intravenous Infusion — Medical Benefit Drug Policy

Policy CodePolicy CS2026D0039AD

Change TypeAdministrative template update and removal of state-specific language

Effective DateApril 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization with documentation that indication-specific criteria and prior DMARD/targeted immunomodulator trials or rationale are met; initial authorizations are typically limited to 12 months (4 doses for acute GVHD).

SourceLink

POLICY UPDATE CHANGES

Template update and removal of content/language pertaining to the state of Louisiana; previous policy version archived (CS2025D0039AC).

12 monthsInitial auth duration

4 dosesAcute GVHD limit

J0129HCPCS

States excludedState guidance

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

04/01/2026Revision date

Coverage Criteria and Evidence Summary

Covered indications with initial and continuation criteria

Covered when ALL of the following are met (per indication and initial vs continuation):

PJIA initial: Diagnosis of moderately to severely active polyarticular juvenile idiopathic arthritis; Orencia initiated and titrated according to FDA‑labeled dosing for PJIA; patient is not receiving Orencia in combination with a targeted immunomodulator (e.g., etanercept, certolizumab, golimumab, adalimumab, tofacitinib, baricitinib, upadacitinib); prescribed by or in consultation with a rheumatologist; initial authorization for no more than 12 months

PJIA continuation: Patient has previously received Orencia IV; documentation of a positive clinical response; Orencia dosed according to FDA‑labeled dosing for PJIA; patient is not receiving Orencia in combination with a targeted immunomodulator; authorization for no more than 12 months

RA initial: Diagnosis of moderately to severely active rheumatoid arthritis; AND one of the following: history of failure or intolerance to a 3‑month trial of one non‑biologic DMARD at maximally indicated doses (unless contraindicated), OR prior treatment with a targeted immunomodulator FDA‑approved for RA, OR patient is currently on Orencia; Orencia initiated and titrated per FDA labeling for RA; patient is not receiving Orencia in combination with a targeted immunomodulator; prescribed by or in consultation with a rheumatologist; initial authorization for no more than 12 months3 months

RA continuation: Patient has previously received Orencia IV; documentation of a positive clinical response; Orencia dosed according to FDA‑labeled dosing for RA; patient is not receiving Orencia in combination with a targeted immunomodulator; authorization for no more than 12 months

PsA initial: Diagnosis of active psoriatic arthritis; AND one of the following: history of failure to a 3‑month trial of methotrexate at maximally indicated dose (unless contraindicated), OR prior treatment with a targeted immunomodulator FDA‑approved for PsA, OR patient is currently on Orencia; Orencia initiated and titrated per FDA labeling for PsA; patient is not receiving Orencia in combination with a targeted immunomodulator; prescribed by or in consultation with a rheumatologist or dermatologist; initial authorization for no more than 12 months3 months

PsA continuation: Patient has previously received Orencia IV; documentation of a positive clinical response; Orencia dosed according to FDA‑labeled dosing for PsA; patient is not receiving Orencia in combination with a targeted immunomodulator; authorization for no more than 12 months

Chronic GVHD initial: Diagnosis of steroid‑refractory chronic graft‑versus‑host disease; AND one of the following: patient is receiving Orencia with systemic corticosteroids, OR patient is intolerant to systemic corticosteroid therapy; initial authorization for no more than 12 months

Chronic GVHD continuation: Documentation of positive clinical response; patient continues to experience chronic GVHD; AND one of: receiving Orencia with systemic corticosteroids, OR intolerant to systemic corticosteroid therapy, OR successfully tapered off corticosteroids; authorization for no more than 12 months

Acute GVHD (prophylaxis): Patient is ≥ 2 years of age; AND undergoing HSCT from a matched donor or a 1 allele‑mismatched unrelated donor; AND receiving Orencia in combination with a calcineurin inhibitor and methotrexate; authorization is for no more than 4 dosesage >=2 years; <=4 doses

ICI‑related severe immunotherapy toxicity: Recent checkpoint inhibitor therapy with diagnosis of severe (Grade 3) or life‑threatening (Grade 4) immunotherapy‑related myocarditis, pericarditis, arrhythmia, impaired ventricular function, or conduction abnormality; no improvement within 24 hours of pulse‑dose methylprednisolone; history of failure, contraindication, or intolerance to infliximab; authorization for no more than 4 doses24 hours

Psoriatic Arthritis — efficacy evidence

Clinical trial evidence supporting use

PsA Phase 3 evidence: Randomized Phase 3 trial of SC abatacept 125 mg weekly vs placebo for 24 weeks demonstrated a significantly higher ACR20 response at week 24 (39.4% vs 22.3%; p < 0.001); modest impact on psoriasis lesions; benefits observed regardless of prior TNF inhibitor exposure; efficacy maintained to week 52; generally well tolerated

Rheumatoid Arthritis — evidence and dosing forms

Comparative and early RA trial findings

SC vs IV noninferiority: Phase 3b double‑blind study showed SC abatacept (125 mg weekly with IV loading) was noninferior to IV abatacept (10 mg/kg) for ACR20 at month 6 (76.0% vs 75.8%) with similar safety and comparable rates of serious adverse events; injection‑site reactions ≈2.5%

Early RA (AVERT): AVERT trial: abatacept plus methotrexate superior to methotrexate alone for DAS28(CRP) < 2.6 at 12 months (60.9% vs 45.2%; p = 0.010); some sustained remission after withdrawal; safety comparable to methotrexate

Polyarticular Juvenile Idiopathic Arthritis (PJIA)

Pivotal pediatric evidence and long-term data

PJIA efficacy and PK: Phase 3 open‑label study of weight‑tiered weekly SC abatacept (50 mg for 10–<25 kg; 87.5 mg for 25–<50 kg; 125 mg for ≥50 kg) produced target therapeutic exposures and high JIA‑ACR response rates at month 4 (cohort 1 JIA‑ACR30 83.2%) with responses maintained to month 24; long‑term extension up to 7 years showed sustained efficacy and consistent safety

Prophylaxis of Acute Graft Versus Host Disease (aGVHD)

Clinical study outcomes for abatacept added to CNI and MTX

GVHD efficacy signals: Clinical cohorts (GVHD‑1, GVHD‑2) evaluating abatacept plus a calcineurin inhibitor and methotrexate used 10 mg/kg IV on Day −1 and Days 5, 14, 28 and reported improved Day‑180 overall survival and some GVHD‑free survival measures (e.g., GVHD‑2 OS 98% vs 75% in comparator analyses), although some randomized endpoints (grade III‑IV GFS) were not significantly improved

Dosing per study: 10 mg/kg IV (max 1000 mg) Day −1, 5, 14, 28

Multiple Sclerosis

Negative or safety‑concern trials

MS trials: ACCLAIM Phase II trial did not demonstrate efficacy (no significant reduction in new Gd+ MRI lesions) and a separate Phase II study was terminated early due to safety concerns (one abatacept dose group had increased Gd‑enhancing lesions and at least one MS exacerbation), providing insufficient evidence to support use in multiple sclerosis

Systemic Lupus Erythematosus (SLE)

Negative Phase II results

SLE trial: Phase II randomized, double‑blind, placebo‑controlled study in SLE failed to meet its primary endpoint (proportion experiencing a new SLE flare over 12 months), and thus does not support routine use of abatacept for systemic lupus erythematosus

Uveitis Associated with Behçet's Disease

Insufficient evidence

Behçet's uveitis: Currently insufficient published peer‑reviewed evidence of safety and efficacy of abatacept for uveitis associated with Behçet's disease; not supported by clinical literature

Guideline-aligned positioning and treatment strategy

Professional society recommendations that influence coverage sequencing

PsA guideline placement: 2018 ACR/National Psoriasis Foundation guidance generally recommends switching to a TNF inhibitor, IL‑17 inhibitor, or IL‑12/23 inhibitor over abatacept (conditional recommendation, low‑quality evidence); abatacept may be considered if TNF inhibitors are contraindicated or in patients with recurrent/serious infections or preference for IV dosing; AAD guidance supports biologic use for moderate‑severe PsA

RA treat‑to‑target: 2021 ACR RA guideline emphasizes a treat‑to‑target approach, methotrexate as initial therapy for many patients, and conditional recommendations for when to initiate or switch biologic/targeted therapies, informing sequencing before abatacept use

Guideline-based recommendations

Recommendations and preferred actions where specified (conditional or strong) for DMARD management, treatment modification, and specific patient populations.

DMARD‑experienced management: Treat‑to‑target approach is conditionally recommended over usual care for patients with inadequate response to bDMARDs/tsDMARDs; methotrexate monotherapy is preferred over methotrexate plus bDMARD/tsDMARD and over bDMARD/tsDMARD monotherapy in many settings; initiate/titrate methotrexate to ≥15 mg weekly within 4–6 weeks when indicated; use split dosing, subcutaneous methotrexate, or increased folic/folinic acid for intolerance before switching DMARDs

Treatment modification: For patients not at target on maximally tolerated methotrexate, adding a bDMARD or tsDMARD is conditionally recommended over triple csDMARD therapy; switching classes is preferred over switching within class; add/switch to DMARDs preferred over continued glucocorticoids; graded preferences provided for continuation, dose reduction, gradual discontinuation, then abrupt discontinuation in patients at target ≥6 months

Specific populations - nodules/pulmonary/lymphoproliferative: Methotrexate conditionally preferred for patients with subcutaneous nodules or mild/stable pulmonary disease; rituximab conditionally preferred for prior lymphoproliferative disorder when approved; apply population‑specific recommendations to sequencing of biologics

Orencia (abatacept) is not medically necessary and is considered unproven for the following indications: multiple sclerosis, systemic lupus erythematosus (SLE), and uveitis associated with Behçet's disease.

Available clinical evidence does not support use of abatacept for certain autoimmune conditions. In relapsing–remitting multiple sclerosis, the ACCLAIM Phase II trial did not show a statistically significant reduction in new gadolinium‑enhancing MRI lesions or clinical benefit, and a separate Phase II study was terminated early because of safety concerns in one dose group. For systemic lupus erythematosus (SLE), a randomized Phase II study failed to meet its primary endpoint of reducing new SLE flares over 12 months. For Behçet's-associated uveitis, published peer‑reviewed evidence of safety and efficacy is currently insufficient.

The Orencia prescribing information advises that concomitant administration with tumor necrosis factor (TNF) antagonists or with other biologic RA therapies (e.g., anakinra) is not recommended. Controlled RA trials showed higher overall and serious infection rates with combined Orencia + TNF antagonist therapy and did not demonstrate added benefit; therefore concurrent biologic combination therapy is contraindicated by labeling and not supported by clinical evidence.

This policy explicitly lists the following uses as unproven / not medically necessary: multiple sclerosis (no demonstrated efficacy in ACCLAIM and safety concerns in a separate Phase II), systemic lupus erythematosus (SLE) (Phase II study failed to meet primary endpoint), and uveitis associated with Behçet's disease (insufficient published evidence of safety and efficacy).

The policy summarizes the clinical trial context for MS and SLE: abatacept did not demonstrate efficacy in the ACCLAIM Phase II RRMS trial (no significant difference in new Gd+ MRI lesions or clinical measures), and a separate RRMS study was stopped early for safety signals in one dose group. In SLE, a Phase II randomized trial failed to meet the primary endpoint of reducing new flares over a 12‑month double‑blind period, indicating lack of supportive evidence for routine SLE use.

Concurrent use of Orencia with other biologic rheumatoid arthritis therapies is not supported. The FDA labeling states Orencia should not be administered concomitantly with TNF antagonists or with other biologic RA therapy (such as anakinra); controlled trials reported higher infection rates with combination therapy and no added efficacy, so concurrent biologic therapy is not considered appropriate.

Billing and Diagnosis Codes

HCPCSHCPCS

J0129

Injection, abatacept, 10 mg

ICD-10 (selected excerpts)ICD-10

D89.811	Chronic graft-versus-host disease
D89.812	Acute on chronic graft versus host disease
L40.50	Arthropathic psoriasis, unspecified
L40.51	Distal interphalangeal psoriatic arthropathy
L40.52	Psoriatic arthritis mutilans
L40.53	Psoriatic spondylitis
L40.54	Psoriatic juvenile arthropathy
L40.59	Other psoriatic arthropathy
M05.00	Felty's syndrome, unspecified site

ICD-10 Diagnosis Codes (Rheumatoid/ Juvenile Arthritis and related)ICD-10

M05.449	Rheumatoid myopathy with rheumatoid arthritis of unspecified hand.
M05.451	Rheumatoid myopathy with rheumatoid arthritis of right hip.
M05.452	Rheumatoid myopathy with rheumatoid arthritis of left hip.
M05.459	Rheumatoid myopathy with rheumatoid arthritis of unspecified hip.
M05.461	Rheumatoid myopathy with rheumatoid arthritis of right knee.
M05.462	Rheumatoid myopathy with rheumatoid arthritis of left knee.
M05.469	Rheumatoid myopathy with rheumatoid arthritis of unspecified knee.
M05.471	Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot.
M05.472	Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot.
M05.479	Rheumatoid myopathy with rheumatoid arthritis of unspecified ankle and foot.

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Operational Requirements and Prior Authorization

Prior Authorization

Prior authorization required

Prior authorization is required. Requests must document that the specific indication criteria are met (e.g., diagnosis, prior DMARD or targeted immunomodulator failure or intolerance, dosing per FDA label, prescriber specialty) and initial authorizations are generally limited to 12 months (4 doses for acute GVHD).

Document diagnosis and indication-specific criteria
Show history of required prior therapy or current use of Orencia when applicable
Confirm dosing follows FDA-labeled instructions
Ensure prescriber specialty requirement (e.g., rheumatologist, dermatologist) is met

Note

Prior authorization not specified

No additional or alternative prior authorization rules or specific CPT/HCPCS beyond the standard J0129 listing are specified in the referenced sections.

Follow standard prior authorization process using the policy criteria above

Background and Drug Information

Background: Orencia (abatacept) is a selective co‑stimulation modulator indicated for several autoimmune disorders under specific conditions. The intravenous formulation covered by this medical benefit policy is used for adult rheumatoid arthritis, adult psoriatic arthritis, and pediatric polyarticular juvenile idiopathic arthritis (age ≥2 years), and has been studied for graft‑versus‑host disease prophylaxis. The IV product should be dosed according to the FDA label and, per labeling, must not be given concomitantly with TNF antagonists or certain other biologic RA agents. Subcutaneous formulations are managed under the pharmacy benefit and require appropriate patient training for self‑administration.

Definitions and Dosing Key Values

Orencia formulation handling

Formulation coverageIV abatacept (Orencia) is managed under the medical benefit; self-administered subcutaneous abatacept is obtained under the pharmacy benefit.

Policy scopeThis policy specifically refers to Orencia injection for intravenous infusion and does not govern SC dispensing or pharmacy benefit coverage.

Administration settingIV formulation administered per FDA‑label infusion instructions (e.g., 60‑minute infusion for IV doses when indicated).

Orencia (abatacept)

Molecular classFully human, soluble, fusion protein (selective co‑stimulation modulator).

Primary actionInhibits T‑lymphocyte activation by binding CD80 and CD86, blocking interaction with CD28.

Policy Revision History

2026-04-01revisionLatest

Administrative template update and removal of state-specific content (Louisiana); previous policy version CS2025D0039AC archived.

Policy Summary

PayerUnitedHealthcare

PolicyOrencia (abatacept) Injection for Intravenous Infusion — Medical Benefit Drug Policy

Policy CodePolicy CS2026D0039AD

Change TypeAdministrative template update and removal of state-specific language

Effective DateApril 1, 2026

Next Review DateN/A

SourceLink

On This Page

Specific populations - heart failure/hepatitis/NAFLD/infection: For NYHA III/IV heart failure non‑TNF inhibitor bDMARD or tsDMARD preferred over TNF inhibitors; prophylactic antiviral therapy strongly recommended when initiating rituximab in HBcAb+ patients; monitoring or prophylaxis recommendations vary by HB status for other biologics; methotrexate conditionally preferred in NAFLD without advanced fibrosis; after recent serious infection prefer csDMARD additions over bDMARD/tsDMARDs

NTM lung disease guidance: Use lowest possible glucocorticoid dose or discontinue if possible; prefer adding csDMARDs over bDMARDs/tsDMARDs for NTM lung disease uncontrolled on csDMARDs; abatacept is conditionally recommended over other bDMARDs/tsDMARDs for patients with NTM lung disease who remain active despite csDMARDs

Juvenile idiopathic arthritis guidance: For children/adolescents with polyarticular JIA initiating a biologic (including abatacept), combination therapy with a csDMARD is conditionally recommended over biologic monotherapy; subsequent therapy choices depend on prior biologic exposure and disease activity (cJADAS‑10 > 2.5), with conditional preferences for switching to non‑TNFi biologics after TNFi failure

Prior Authorization

PJIA — weight-tiered dosing & response timing

For polyarticular juvenile idiopathic arthritis, pediatric weight-tiered SC dosing and response timing are described and inform authorization: weight-based weekly dosing with response assessment at month 4; IV/SC dosing must follow FDA labeling.

SC weight-tiered dosing: 10–<25 kg = 50 mg; 25–<50 kg = 87.5 mg; ≥50 kg = 125 mg (weekly)
Response evaluated by JIA-ACR criteria at month 4 to support continuation

Note

Check benefit requirements and use of utilization tools

Check federal, state, and contractual benefit requirements when making coverage decisions; UnitedHealthcare may use third-party utilization tools (e.g., InterQual) to assist in administration.

Confirm plan-specific terms govern in case of conflict with standard policy
Be prepared for third-party criteria to be applied during review

Step Therapy

Step therapy requirements for RA and PsA

For rheumatoid arthritis and psoriatic arthritis, step therapy requires prior trial and failure or intolerance to a 3-month trial of a non-biologic DMARD (RA) or a 3-month trial of methotrexate (PsA) at maximally indicated doses unless contraindicated, or prior treatment with a targeted immunomodulator, unless the patient is currently on Orencia.

RA: 3-month trial of one non-biologic DMARD (e.g., methotrexate, leflunomide, sulfasalazine, hydroxychloroquine) at maximally indicated dose unless contraindicated
PsA: 3-month trial of methotrexate at maximally indicated dose unless contraindicated
Prior targeted immunomodulator therapy (FDA-approved for indication) satisfies step requirement

Step Therapy

Step therapy not specified

Some sections do not specify additional step therapy beyond the requirements already listed; where not described, follow the indication-specific criteria in the policy.

If no step therapy is specified for an indication, apply the policy's initial/continuation criteria

Step Therapy

Psoriatic arthritis — guideline-preferred sequence

Guidelines for psoriatic arthritis generally recommend switching to TNF inhibitors, IL-17 inhibitors, or IL-12/23 inhibitors over abatacept; abatacept may be considered when TNFi are contraindicated or for patients with recurrent/serious infections, supporting its placement after or instead of other biologics depending on contraindications.

Consider TNFi, IL-17i, or IL-12/23i before abatacept per ACR/NPF guidance
Abatacept may be considered if TNFi are contraindicated or infection risk is a concern

Note

Guideline-informed sequencing

Guideline-informed sequencing emphasizes treat-to-target and methotrexate initiation/titration strategies, with conditional recommendations to add or switch to bDMARDs/tsDMARDs when patients are not at target despite maximally tolerated methotrexate.

Initiate/titrate methotrexate to ≥15 mg weekly within 4–6 weeks when appropriate
Add or switch to a bDMARD/tsDMARD over triple csDMARD therapy for patients not at target on maximally tolerated methotrexate

Documentation Required

Continuation documentation

For continuation requests, documentation must show prior receipt of Orencia IV and a positive clinical response; dosing must remain per FDA labeling and concurrent use with targeted immunomodulators is disallowed.

Confirm prior administration of Orencia IV
Provide objective documentation of clinical improvement
Verify continued adherence to FDA dosing and absence of concurrent targeted immunomodulator

Billing Rule

Diagnosis code listings

Use the listed ICD-10 diagnosis codes for rheumatoid arthritis, juvenile arthritis, graft-versus-host disease, and psoriatic arthritis when submitting requests; an extensive set of RA/JIA codes is provided in the policy.

HCPCS J0129 is the listed procedure code for abatacept (injection, abatacept, 10 mg)
Reference the detailed ICD-10 lists for RA and JIA variants when coding

Documentation Required

GVHD prophylaxis documentation

For prophylaxis of acute GVHD, document the clinical trial dosing and timing (intravenous abatacept 10 mg/kg, maximum 1000 mg, given Day -1 and Days 5, 14, and 28) and concurrent use with a calcineurin inhibitor and methotrexate to support use.

IV dosing: 10 mg/kg (max 1000 mg) on Day -1, then Days 5, 14, and 28
Document concomitant calcineurin inhibitor and methotrexate use
Authorization for aGVHD limited to no more than 4 doses

Documentation Required

Administration and plan governance

Follow FDA labeling for indications and administration instructions; when subcutaneous administration is appropriate, document patient or caregiver training per the prescribing information and confirm plan-specific governance applies.

Adhere to FDA-labeled indications and administration
Document training for self-administration of subcutaneous Orencia when used
Verify federal, state, or contractual plan requirements that may govern coverage

Denial Risk

Concurrent targeted immunomodulator exclusion

Concurrent use of Orencia with targeted immunomodulators or TNF antagonists and certain other biologic RA therapies is not supported; concurrent combination therapy is a reason therapy would not meet criteria and may be denied.

Do not combine Orencia with TNF antagonists or other biologic RA therapies (e.g., anakinra)
Concurrent administration was associated with higher infection rates in trials and is not supported by clinical evidence

Denial Risk

No denial triggers listed in provided sections

No explicit denial triggers beyond the listed exclusions and not medically necessary statements are provided in the referenced sections.

Apply the policy's exclusions (e.g., MS, SLE, Behçet's-associated uveitis) and contraindications when assessing denials

Denial Risk

SLE — insufficient efficacy

The Phase II SLE study failed to meet its primary endpoint (no reduction in new SLE flares over 12 months), supporting that abatacept for systemic lupus erythematosus is not supported and could be denied as not medically necessary.

Document that SLE use lacks demonstrated efficacy per the randomized Phase II trial

Denial Risk

Multiple sclerosis — not supported

Multiple sclerosis indications are not supported by the evidence: ACCLAIM did not show efficacy and another Phase II was terminated early for safety concerns, which could lead to denial for MS.

ACCLAIM showed no significant reduction in new Gd+ MRI lesions
Early termination of a Phase II due to increased lesions/exacerbations in one dosing group

Denial Risk

Concurrent biologic therapy risk

Concurrent administration of Orencia with TNF antagonists or certain other biologic RA therapies was linked to higher overall and serious infection rates in trials and is not supported by clinical evidence; coverage decisions may deny concurrent biologic therapy.

Trials reported more infections (63% vs 43%) and serious infections (4.4% vs 0.8%) with concurrent Orencia plus TNF antagonists
Labeling states Orencia should not be administered concomitantly with TNF antagonists or certain other biologic RA therapy

Clinical relevanceModulation of T‑cell costimulation reduces downstream inflammatory signaling in autoimmune diseases treated with abatacept.

ACR20

DefinitionACR20 = ≥20% improvement in swollen and tender joint counts (primary endpoint in the referenced PsA Phase 3 trial).

Use in trialsPrimary efficacy endpoint in Phase 3 psoriatic arthritis study assessing abatacept vs placebo at week 24.

Reported resultIn the PsA trial, ACR20 at week 24: abatacept 39.4% vs placebo 22.3% (p<0.001).

Mechanism of action

Targeted interactionBinds to CD80 and CD86 on antigen‑presenting cells.

Downstream effectPrevents CD28‑mediated costimulatory signal required for full T‑lymphocyte activation.

Therapeutic implicationReduces T‑cell driven inflammation across indications where T‑cell costimulation contributes to pathogenesis.

JIA weight-tiered SC dosing

Weight-tier 10 to <25 kg50 mg subcutaneously once weekly.

Weight-tier 25 to <50 kg87.5 mg subcutaneously once weekly.

Weight-tier ≥50 kg125 mg subcutaneously once weekly.

GVHD prophylaxis IV dosing

Dose and frequency10 mg/kg IV (maximum 1,000 mg) administered as intravenous infusion.

Timing relative to HSCTFirst dose on Day -1 (day before transplantation), then on Days 5, 14, and 28 post‑transplant.

Concomitant therapyGiven in combination with a calcineurin inhibitor (CNI) and methotrexate (MTX) per studied regimen.

Treat-to-target

Core conceptTreat‑to‑target: regularly adjust therapy to achieve and maintain predefined disease activity targets rather than usual care.

Guideline contextConditionally recommended over usual care for DMARD‑experienced patients not at target.

Implication for sequencingSupports escalation to or switching among DMARDs/biologics based on target attainment, informing coverage sequencing and prior authorization decisions.