Abstract
The gold standard of therapy for patients with juvenile idiopathic arthritis (JIA), previously referred to as juvenile rheumatoid arthritis (JRA), has been methotrexate and, if methotrexate fails, a biological agent. Leflunomide, an oral pyrimidine synthesis inhibitor, has been shown to be well tolerated and effective in both short-term and long-term studies of adult rheumatoid arthritis (RA). This article reviews the current state-of-the-art use of leflunomide in JIA. A Phase Ib study demonstrated that leflunomide is effective in patients who have either failed methotrexate or are intolerant of methotrexate (50% American College Rheumatology [ACR] Pedi 30). Following the encouraging results of this initial study, a large, multicentered comparator study of leflunomide versus methotrexate was performed. This study demonstrated that both drugs had excellent response rates (ACR Pedi 30 rates of 68 and 89%, respectively) although there was a statistically significant higher response rate for methotrexate.
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