PReS-FINAL-2094: Evaluation of the benefits of sequential addition of leflunomide in patients with polyarticular course juvenile idiopathic arthritis failing standard dose methotrexate

Methotrexate (MTX), the disease modifying antirheumatic drug (DMARD) of first choice in juvenile idiopathic arthritis (JIA), is not effective in 45-50% of patients with polyarticular course JIA. In developed countries, when MTX fails, the next step is to start biologicals. In resource limited settings this step is constrained by prohibitive cost and children failing MTX run the risk of poor disease control or steroid overuse. There is paucity of data on use of other DMARDs or their combinations in such children. MTX and leflunomide (LEF) are known to have differing and complementary actions in modifying the immune response and this combination has been studied in adults. Their combined cost is a fraction of the cost of biologicals.