Background Leflunomide is a disease modifying drug (DMARD) used in the treatment of juvenile idiopathic arthritis (JIA). Chronic uveitis is a frequent complication of JIA. Methotrexate and other DMARDS have successfully been used in the treatment of this condition. However, few data is available of the effect of leflunomide treatment on concurrent chronic uveitis in JIA.
Objectives To investigate the effect of leflunomide treatment on the course of uveitis in JIA and to determine the number of flares of uveitis in patients with previous uveitis treated with leflunomide.
Methods The database of the German Center for Pediatric Rheumatology was searched for all patients with diagnosis of juvenile idiopathic arthritis and chronic uveitis and treatment with leflunomide from January 2010 until October 2011. Patients older than 18 years of age or with uveitis for other causes were excluded. Patients were divided into two subgroups: (I) active uveitis and (II) inactive uveitis at start of leflunomide treatment. A retrospective chart survey was used to extract demographic data, uveitis activity using SUN working group criteria, dosage of leflunomide and length of treatment and concurrent medications, including DMARD and biologic agents. Primary endpoints for the subgroups were: (I) change in SUN criteria at start of leflunomide treatment and last follow-up, and (II) occurrence of flare during leflunomide treatment. Analysis was performed using descriptive statistics and Wilcoxon matched pairs test.
Results 16 patients were included in the study, 10 with active and 6 with inactive disease at start of leflunomide treatment. Median dose of leflunomide was 20 mg per day (range 10 – 20 mg) over a median period of 10 months (range 3 - 53 months). Preceding medications were methotrexate in 100%, azathioprine in 63%, cyclosporine in 25% and etanercept in 19% of patients. Concurrent treatment was adalimumab in 56%, etanercept and infliximab in 13% each of patients. Patients with active disease showed a median drop of uveitis activity from 1+ (range 0 – 2+) to no activity (range 0 – 2+) at last follow-up (p=0.024). Of 6 patients with inactive disease, 1 showed a flare of uveitis during treatment with leflunomide. Of note, 2 patients showed a flare of uveitis 6 and 13 months after discontinuation of leflunomide treatment, respectively.
Conclusions Leflunomide may be of benefit in the treatment of refractory uveitis alone or in combination with biological agents. Further research including controlled trials is necessary to assess leflunomide efficacy in chronic uveitis associated with JIA.
Disclosure of Interest None Declared
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