Who is this relevant for?

  • Pharmaceutical buyers sourcing shortage medicines
  • Hospitals managing supply risk
  • Distributors monitoring sourcing opportunities

The UK has lost licensed supply of triamcinolone hexacetonide (TH) and triamcinolone acetonide (TA), both essential for intra-articular injections in juvenile idiopathic arthritis (JIA). Production stopped in the UK in the 2020s. By 2024, TH was completely absent. In 2025, TA production also ceased. Currently, only unlicensed imports are available, at higher cost and with no pediatric license.

A BSR survey of 95 centres found that most paediatric units now rely on methylprednisolone acetate (MeA) or hydrocortisone sodium phosphate (HySP) as alternatives. These are less effective and shorter-acting. MeA was used by 40% of paediatric centres, HySP by 10%. None used dexamethasone or betamethasone.

The switch to shorter-acting alternatives means more frequent injections, often requiring general anaesthesia. That increases hospital visits, time away from school, and pressure on NHS theatre capacity. The survey confirmed that clinicians see TH as superior in duration of action compared to TA, and both as superior to MeA and HySP.

For pharmaceutical buyers and distributors, this shortage represents a sustained demand for unlicensed imports. The market is fragmented: some specialist centres can access imports; others cannot. That creates geographic inequalities and inconsistent demand patterns. Supply chain resilience for these small-volume corticosteroids remains low because global manufacturing is concentrated and market incentives are weak.

Off-label use carries liability for prescribers. Dosing extrapolation from adults to children is risky. Any supplier offering unlicensed TH or TA must provide clear documentation and support for dosing, given the absence of licensed alternatives.

The BSR continues to monitor the situation, but structural solutions – like government incentives for domestic production – have not materialised. For now, the shortage is a long-term sourcing challenge rather than a temporary disruption.