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Leflunomide Use in Juvenile Idiopathic Arthritis Following Methotrexate Discontinuation: A One-Year Clinical Practice Retrospective Review

Vicenç Torrente-Segarra, Rosa Bou, Sílvia Ricart, Palmira Santín, Natàlia Rodríguez, Joan Ros, Jordi Antón-López.

Abstract
OBJECTIVE: to assess leflunomide (LFN) efficacy in Juvenile Idiopathic Arthritis (JIA) in clinical practice.

METHODS: we conducted a retrospective chart review from 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 (TJC), swollen (SJC) and limited rang of motion joint count, ESR, CPR, antinuclear antibodies (ANA), and liver enzymes levels.

RESULTS: seventeen patients received LFN. 82% were female, mean age at diagnosis 5.3 years old (±3.8), mean age at LFN onset 12.3 years (±6.4). 53% were ANA positive olygoarticular JIA, 35% extended olygoarthritis, % systemic onset and 6% RF negative polyarthritis. 35% of patients received LFN due to MTX partial response, 35% due to MTX side effects, and 28% due to MTX intolerance.
Baseline TJC and SJC mean were 2.61 and 2.54, respectively. Thirteen patients (76%) also received combined after the first 3. Four patients showed good response to LFN (three were ANA positive olygoarthritis). No major side effects were seen, and LFN was well tolerated in all patients. ESR was normal in all patients at baseline.

CONCLUSION: following MTX discontinuation, we found LFN led to clinical remission in 33% of ANA positive olygoarticular JIA after 3 months. LFN showed an acceptable safety profile in combination with anti-TNF therapy.

Key words: Juvenile Idiopathic Arthritis; Leflunomide, Combined Therapy.



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