Leflunomide Use in Juvenile Idiopathic Arthritis Following Methotrexate Discontinuation: A One-Year Clinical Practice Retrospective Review
Annals of the Pediatric Rheumatology (APR)
Objective: The goal of this study was to assess leflunomide (LFN) efficacy in juvenile idiopathic arthritis (JIA) in clinical practice. Methods: We conducted a retrospective chart review of all JIA patients who received LFN between 2006 and 2011. We collected baseline JIA sociodemographics and the following data in order to assess LFN efficacy and safety at 3, 6, and 12 months after LFN initiation: tender joint count (TJC), swollen joint count (SJC), limited range of motion joint count,
... oint count, erythrocyte sedimentation rate (ESR), C-reactive protein, antinuclear antibodies (ANA), and liver enzyme levels. Results: Seventeen patients received LFN, 82% of whom were female. The mean age at diagnosis was 5.3 years old (±3.8 years), and the mean age at LFN onset was 12.3 years (±6.4 years). Fifty-three percent of patients were ANA-positive with olygoarticular JIA, 35% had extended olygoarthritis, % had systemic onset JIA, and 6% had polyarticular JIA (RF negative). Thirty-five percent of patients received LFN due to a partial response to methotrexate (MTX), 35% received LFN due to MTX side effects, and 28% received LFN due to MTX intolerance. At baseline, mean TJC and SJC were 2.61 and 2.54, respectively. Thirteen patients (76%) also received combined after the first 3. Four patients showed a good response to LFN (three had ANA-positive olygoarthritis). In addition, LFN was well tolerated in all patients, with no major side-effects. ESR was normal in all patients at baseline. Conclusion: The results of this study showed that following discontinuation of MTX, LFN led to clinical remission in 33% of ANA-positive patients with olygoarticular JIA after 3 months. LFN also had an acceptable safety profile in combination with anti-TNFα therapy.