Start Time Optimization of Biologics in Polyarticular JIA

STOP-JIA is a prospective, observational study comparing the clinical effectiveness and
impact on patient reported outcomes of 3 different treatment strategies (CTPs) in new onset
pJIA patients to answer the critical question of when to start biologic medications. All
participants will be enrolled in the CARRA Registry and started on one of the CTPs, which
will be decided by the treating physician and patient/caregiver. Subjects will be enrolled at
one of 60 participating CARRA sites across the US and Canada. Total anticipated enrollment is
>400, or 200 patients per year over 2 years of recruitment.

Specific Aim 1:

To compare the clinical effectiveness of different strategies (CTPs) for using biologic
medications in achieving clinically inactive disease (CID) at 12 months in new-onset pJIA.
Three common strategies that differ in the timing of biologic medication introduction will be
compared: 1) Step-Up: disease modifying anti-rheumatic drug (DMARD) monotherapy stepping up
by addition of a biologic medication if needed; 2) Early Combination: DMARD plus biologic
medication at treatment onset; and 3) Biologic First: biologic medication monotherapy at
treatment onset.

Hypothesis 1: A significantly higher proportion of children started on a biologic medication
at onset (CTP 2 or 3) will achieve CID after 12 months of therapy compared to standard
therapy (CTP 1).

Specific Aim 2:

To compare patient and caregiver reported outcomes between the different strategies.

Hypothesis 2: There will be statistically significant differences in patient/caregiver
reported outcomes (PROs) between treatment strategies that can inform future patients and
providers in selecting optimal treatments.

The CARRA Registry will be housed at CARRA's clinical and data coordinating center, Duke
Clinical Research Institute (DCRI). The CARRA Registry Protocol documents that the CARRA
Registry fulfills all PCOR standards for registries. STOP-JIA will utilize data collection,
storage, and management processes, systems requirements, and security processes already
established for the CARRA Registry at DCRI.

STOP-JIA will use Web-based electronic CRFs (eCRFs) developed for the CARRA Registry that are
already familiar to site personnel. The eCRF platform, RAVE, is 21CFR part11 compliant and
meets regulatory requirements. Database and Web servers are secured by a firewall and through
controlled physical access. eCRFs will be monitored for completeness, accuracy, and attention
to detail throughout the study by DCRI data and site management teams using processes
developed for the CARRA Registry and consistent with DCRI's internal SOPs. Use of electronic
data capture will allow for immediate prompts/queries if entered values are out of expected
ranges or there are incomplete data fields. The design of the data collection instrument will
allow centers to record a planned assessment of a patient was missed and to enter any known
reasons for the assessment being missed. DCRI will regularly provide reports detailing data
completion metrics to the sites. Stakeholder engagement is also an important aspect of this
study, and patients/caregivers as well as other stakeholders are serving as research partners
and advisors in this study.

Inclusion Criteria:

- Age less than 19 at baseline (if 18 or older, agrees to be followed for at least one
year)

- Diagnosis of Arthritis per ACR definition.

- Arthritis present in one joint for a least six weeks

- At least 5 active joints at baseline

- Contraception if sexually active (male and female)

May have any of the following:

- RF+ polyarticular JIA

- RF- polyarticular JIA

- Extended oligoarticular JIA

- Psoriatic JIA

- Enthesitis related JIA

- Undifferentiated JIA

- Psoriasis

- Sacroiliitis

- Uveitis

- Enthesitis

- Prior treatments permitted:

- NSAIDS

- Hydroxychloroquine

- Intraocular / topical / intraarticular glucocorticoids

- IV or PO steroids if one of the below criteria are met:

--If treated ≤ 3 months prior to baseline: treatment cannot exceed 2 weeks

--If treated > 3 months prior to baseline: any treatment course is permitted as
long as treatment was completed 90 days prior to baseline

- Methotrexate started no more than 1 month prior to the baseline visit

- Biologics — received only 1 dose within 1 week of the baseline visit

Exclusion Criteria:

- Features consistent with systemic JIA

- Treatment with any medications for JIA aside from those listed above.

- Known inflammatory bowel disease

- Known celiac disease

- Known Trisomy 21

- History of or current malignancy

- Concomitant serious active or recurrent chronic bacterial, fungal or viral infection

- Significant organ system disorder limiting use of treatments for pJIA

- Live vaccine within a month prior to baseline