Trial of Sequential Medications AfteR TNFi Failure in Juvenile Idiopathic Arthritis

This study is an open-label, randomized, multicenter trial that incorporates a multi-arm design comparing each of 3 non-TNFi (Tumor Necrosis Factor inhibitor) medications to a second TNFi (active control) within a sequential multiple assignment randomized trial design with 2 randomization stages corresponding with clinical decision points. The first randomization addresses whether each of the 3 non-TNFi medications is superior to treatment with a second TNFi. The second randomization allows identification of optimal sequential use of biologics (treatment strategies).

NCT Number	NCT06654882
Lead Sponsor	Duke University Collaborators: Patient-Centered Outcomes Research Institute
Conditions	Polyarticular Course Juvenile Idiopathic Arthritis (JIA)
Enrollment	400 participants
Start Date	2026-01-09
Primary Completion	2029-05-30 (estimated)
Study Completion	2029-11 (estimated)
Updated on ClinicalTrials.gov	2026-08-03