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Effectiveness of leflunomide in patients with juvenile idiopathic arthritis in clinical practice
1Kinder- und Jugendrheumatologie, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Am Klinikum Eilbek, Dehnhaide 120, 22081 Hamburg, Germany. sprechstunde@kinderrheumatologie.de
Insights
Leflunomide effectively improved joint function and reduced pain in children with juvenile idiopathic arthritis (JIA). This treatment was well-tolerated, with many achieving remission or continuing therapy long-term.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Pharmacology
Background:
- Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease affecting children.
- Methotrexate (MTX) is a common first-line treatment, but some patients experience adverse events or lack efficacy.
- Alternative treatment options are needed for children with JIA who do not respond to or tolerate MTX.
Purpose of the Study:
- To evaluate the real-world effectiveness and safety of leflunomide in pediatric patients with JIA.
- To assess changes in joint status, functional ability, and pain in children treated with leflunomide.
Main Methods:
- Retrospective review of medical records for 58 JIA patients initiating leflunomide (April 2001-October 2006).
- Data collected included baseline characteristics, reasons for treatment, adverse events, joint counts, Childhood Health Assessment Questionnaire (CHAQ) scores, and pain/well-being scores.
- Patients either switched from methotrexate (MTX) or had leflunomide added to MTX therapy.
Main Results:
- Leflunomide therapy led to significant reductions in swollen and tender joint counts.
- Improvements were noted in CHAQ scores, pain, and well-being assessments.
- After a mean therapy duration of 1.45 years, 44.8% continued leflunomide, 29.3% achieved remission, and 22.4% discontinued due to side effects.
Conclusions:
- Leflunomide is a safe and effective treatment for JIA in a clinical setting.
- It demonstrates substantial improvements in joint and functional outcomes for pediatric patients.
- Leflunomide offers a viable alternative for JIA patients intolerant or unresponsive to MTX monotherapy.
Objective:
To evaluate the effectiveness of leflunomide in children with juvenile idiopathic arthritis (JIA) as used in actual clinical practice.
Methods:
We conducted a retrospective review of medical records of patients with JIA who initiated leflunomide treatment between April 2001 and October 2006. Data derived from these charts included patient baseline characteristics, reason for starting leflunomide, adverse events, joint outcomes, Childhood Health Assessment Questionnaire (CHAQ) scores, visual analog scale pain and well-being scores, and current treatment status.
Results:
Fifty-eight patients (33 female, 25 male) were included in this study. Forty-eight patients were switched from methotrexate (MTX) to leflunomide, primarily because of MTX-related adverse events, and leflunomide was added to ongoing MTX in 10 patients. The mean duration of leflunomide therapy was 1.45 years. The mean swollen joint count decreased from 1.40 at treatment initiation to 0.60 at last followup, while the mean tender joint count decreased from 1.83 to 0.29. Improvements were also observed in CHAQ, pain, and well-being scores. At last followup, 44.8% of patients were continuing leflunomide therapy, 29.3% had discontinued because of remission, and the rest had discontinued treatment because of side effects (22.4%) or other reasons (3.4%).
Conclusion:
Leflunomide treatment, as employed in actual clinical practice, was well tolerated and resulted in substantial improvements in joint and functional status outcomes in children with JIA. Approximately 30% of the patients attained remission during leflunomide therapy. Leflunomide is thus a safe and effective alternative for patients with JIA who cannot tolerate or do not respond to MTX monotherapy.
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