Abstract
Purpose :
Leflunomide (LEF) is a disease-modifying anti-rheumatic drug (DMARD) approved for rheumatoid and psoriatic arthritis in patients over the age of 18. While off-label use has found it to be effective for treatment of childhood conditions such as juvenile idiopathic arthritis (JIA), there has been a lack of literature and good quality evidence on its efficacy in the treatment of noninfectious pediatric uveitis. The aim of this study is to describe the effectiveness of LEF as adjunctive therapy with anti-Tumor Necrosis Factor (anti-TNF) agents in pediatric patients with uveitis who are not able to tolerate methotrexate (MTX).
Methods :
A retrospective case series was performed with pediatric patients who were treated with LEF in conjunction with anti-TNF agent therapy after intolerance to a combination of MTX with anti-TNF therapy. Dose and duration of MTX, LEF, and anti-TNF therapy were recorded. Extensive history, laboratory data, demographics, and uveitis flare rate were obtained.
Results :
A total of five children were included in the study. Most subjects were initially on MTX and an anti-TNF agent was added subsequently due to inadequate response to monotherapy. After discontinuation of MTX, LEF was initiated with anti-TNF therapy. The replacement of MTX with LEF showed decreased side effects and was associated with lower flare rates and steroid free remission.
Conclusions :
LEF was found to be well-tolerated and effective at maintaining uveitis quiescence in conjunction with anti-TNF agents in pediatric patients who do not tolerate MTX.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.