Produção Nacional
Revisado por pares
A Longterm Prospective Real-life Experience with Leflunomide in Juvenile Idiopathic Arthritis
2013; The Journal of Rheumatology Publishing Company Limited; Volume: 41; Issue: 2 Linguagem: Inglês
10.3899/jrheum.130294
ISSN1499-2752
AutoresA.C.D.C. Alcantara, Christiane Araújo Chaves Leite, Ana Caroline Rocha Melo Leite, José Júlio Costa Sidrim, Francisco Saraiva Silva, Francisco Airton Castro Rocha,
Tópico(s)Acute Lymphoblastic Leukemia research
ResumoObjective. 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). Conclusion. LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.
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