In the absence of a submission from the holder of the marketing authorisation, abatacept (Orencia®) cannot be endorsed for use within NHS Wales in combination with methotrexate for the treatment of moderate to severe active polyarticular juvenile idiopathic arthritis in paediatric patients from 2 years of age to < 6 years of age and older who have had an insufficient response to other disease-modifying anti-rheumatic drugs (DMARDs) including at least one tumour necrosis factor (TNF) inhibitor.