title: A longterm prospective real-life experience with leflunomide in juvenile idiopathic arthritis.
abstract: 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/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).
  
  
  CONCLUSIONS
  LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.
authors: From the Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza CE, Brazil.
authors: Antonia Célia de Castro
authors: AC
authors: Alcântara
authors: Christiane Araújo Chaves
authors: CA
authors: Leite
authors: Ana Caroline Rocha Melo
authors: AC
authors: Leite
authors: José Julio Costa
authors: JJ
authors: Sidrim
authors: Francisco Saraiva
authors: FS
authors: Silva
authors: Francisco Airton Castro
authors: FA
authors: Rocha
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006304:Health Status; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D000077339:Leflunomide; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide; D008727:Methotrexate
keywords: DISEASE ACTIVITY SCORE; DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; JUVENILE IDIOPATHIC ARTHRITIS; LEFLUNOMIDE; METHOTREXATE