A Longterm Prospective Real-life Experience with Leflunomide in Juvenile Idiopathic Arthritis

• Published in: Journal of rheumatology 2014-02, Vol.41 (2), p.338-344
• Main Authors: DE CASTRO ALCANTARA, Antonia Célia, CHAVES LEITE, Christiane Araújo, MELO LEITE, Ana Caroline Rocha, COSTA SIDRIM, José Julio, SARAIVA SILVA, Francisco, CASTRO ROCHA, Francisco Airton
• Format: Article
• Language: English
• Subjects: Adolescent; Antirheumatic Agents - therapeutic use; Arthritis, Juvenile - drug therapy; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Child; Child, Preschool; Diseases of the osteoarticular system; Drug Therapy, Combination; Female; Health Status; Humans; Inflammatory joint diseases; Isoxazoles - therapeutic use; Male; Medical sciences; Methotrexate - therapeutic use; Pharmacology. Drug treatments; Prospective Studies; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.130294

To describe a clinical practice with leflunomide (LEF) in juvenile idiopathic arthritis (JIA). Patients with JIA seen between May 2008 and May 2012 and considered nonresponsive to methotrexate (MTX) were given LEF and prospectively followed. Primary outcome was a 28-joint Disease Activity Score (DAS28) of low disease activity (< 3.2) in less than 6 months. Childhood Health Assessment Questionnaire (CHAQ) scores and safety data were recorded. Forty-three patients (33 female) were included with 25 (58.1%) polyarticular, 10 oligoarticular (7 extended; 3 persistent), 6 systemic, and 2 enthesitis-related. Ten (23.2%) were rheumatoid factor-positive and 7 (16.3%) had antinuclear antibodies. Prior drugs other than MTX: 11 (25.5%) chloroquine diphosphate + MTX and 2 (4.6%) sulfasalazine + MTX; mean prednisone dose was 6.4 ± 9.3 mg. The MTX dose prior to LEF was 14.5 ± 4.5 mg/m(2)/week. LEF dose and duration of therapy were 16.6 ± 5.2 mg/d and 3.6 ± 2.2 years, respectively. Nineteen patients (44.2%) interrupted LEF: 1 entered remission, 11 were nonresponsive, and 7 were intolerant (16.2%). Baseline DAS28 (5.57 ± 0.7) dropped to 3.7 ± 1.2 at final analysis (p < 0.001) and 16 patients (37.2%) had a low DAS28 [< 3.2; 12 (27.9%) while taking LEF + MTX and 4 (9.3%) while taking monotherapy]. At last followup, the number of patients with DAS28 > 5.1 dropped from 34 (79%) to 9 (20.9%) and CHAQ scores from 0.86 ± 0.7 to 0.44 ± 0.5 (p < 0.001). LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.