RT Journal Article
SR Electronic
T1 A Longterm Prospective Real-life Experience with Leflunomide in Juvenile Idiopathic Arthritis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.130294
DO 10.3899/jrheum.130294
A1 Antonia Célia de Castro  Alcântara
A1 Christiane Araújo Chaves  Leite
A1 Ana Caroline Rocha  Melo  Leite
A1 José Julio Costa  Sidrim
A1 Francisco Saraiva  Silva, Jr
A1 Francisco Airton Castro  Rocha
YR 2013
UL http://www.jrheum.org/content/early/2013/12/12/jrheum.130294.abstract
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.