PT  - JOURNAL ARTICLE
AU  - Antonia Célia de Castro  Alcântara
AU  - Christiane Araújo Chaves  Leite
AU  - Ana Caroline Rocha  Melo  Leite
AU  - José Julio Costa  Sidrim
AU  - Francisco Saraiva  Silva, Jr
AU  - Francisco Airton Castro  Rocha
TI  - A Longterm Prospective Real-life Experience with Leflunomide in Juvenile Idiopathic Arthritis
AID  - 10.3899/jrheum.130294
DP  - 2013 Dec 15
TA  - The Journal of Rheumatology
PG  - jrheum.130294
4099  - http://www.jrheum.org/content/early/2013/12/12/jrheum.130294.short
4100  - http://www.jrheum.org/content/early/2013/12/12/jrheum.130294.full
AB  - Objective To describe a clinical practice with leflunomide (LEF) in juvenile idiopathic arthritis (JIA). Methods 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. Results 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/m2/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). Conclusion LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.