Trial of Sequential Medications AfteR TNFi Failure in Juvenile Idiopathic Arthritis

Inclusion Criteria: * Polyarticular course JIA * Moderate or high-disease activity (cJADAS10 \>5) despite treatment with an initial TNFi for ≥3 months * Age ≥2 years and \<18 years and weight ≥ 10kg * No systemic glucocorticoids or systemic glucocorticoids at a stable dose of ≤0.2 mg/kg/day (maximum 10 mg/day) for ≥2 weeks prior to baseline visit * Documented informed consent/assent obtained from the parent/caregiver/patient Exclusion Criteria: * Systemic JIA * Enthesitis-related arthritis/juvenile spondyloarthritis (2001 International League of Associations for Rheumatology \[ILAR\] criteria)30 * History of or currently active inflammatory bowel disease * History of or currently active psoriasis * Active uveitis within 3 months of the baseline visit * History of or currently active sacroiliitis * History of or current malignancy * Active tuberculosis (TB) or a history of incompletely treated TB; Purified Protein derivative (PPD) or QuantiFERON-TB positive patients (without active TB) unless it is documented that the patient has been adequately treated for TB and can start treatment with a biologic agent, based on the medical judgment of the site investigator and/or an infectious disease specialist; suspected extrapulmonary TB infection; or at high risk of contracting TB, such as close contact with individual with active or latent TB * Prior treatment with more than one TNFi molecule; exposure to more than one biosimilar of the same TNFi molecule is allowed * Prior treatme…