Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis

Peter BB Jones1,2, Douglas HN White21Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 2Rheumatology Department, Waikato Hospital, Hamilton, New ZealandAbstract: Leflunomide is a disease-modifying antirheumatic drug (DMARD) that has been in routine clinical use...

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Autores principales:	Peter BB Jones, Douglas HN White
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/7d7a87290fc4437c8b3c13f26dd4880b
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spelling	oai:doaj.org-article:7d7a87290fc4437c8b3c13f26dd4880b2021-12-02T08:18:59ZReappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis1179-156Xhttps://doaj.org/article/7d7a87290fc4437c8b3c13f26dd4880b2010-11-01T00:00:00Zhttp://www.dovepress.com/reappraisal-of-the-clinical-use-of-leflunomide-in-rheumatoid-arthritis-a5593https://doaj.org/toc/1179-156XPeter BB Jones1,2, Douglas HN White21Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 2Rheumatology Department, Waikato Hospital, Hamilton, New ZealandAbstract: Leflunomide is a disease-modifying antirheumatic drug (DMARD) that has been in routine clinical use for the treatment of rheumatoid arthritis (RA) and psoriatic arthritis for a decade. In RA, clinical trials of up to two years&rsquo; duration showed that leflunomide monotherapy was equivalent to methotrexate in clinical and radiographic disease outcomes (tender and swollen joint counts, physician and patient global assessments, American College of Rheumatology and Disease Activity Score responses, slowing or halting of radiographic progression). In a number of studies, quality of life measurements indicated that leflunomide is superior to methotrexate. Leflunomide has been studied in combination with methotrexate and shows efficacy in patients only partly responsive to this agent. Recent trials have shown that leflunomide can be used safely with biologic DMARDs, including antitumor necrosis factor agents and rituximab as part of the treatment algorithm in place of methotrexate as a cotherapy. Leflunomide has demonstrated efficacy as a monotherapy in psoriatic arthritis, and it also has a beneficial effect in psoriasis. Postmarketing studies have shown that retention on treatment with leflunomide is equal to methotrexate and superior to other DMARDs. In general, its side effect profile is acceptable compared with other DMARDS, with nausea, diarrhea, and hair fall occurring commonly, but only rarely leading to discontinuation. Liver toxicity is the most significant problem in clinical use although it is uncommon. Peripheral neuropathy, hypertension, pneumonitis, and cytopenia occur more rarely. Leflunomide is contraindicated in pregnancy and should be used with caution in women during child-bearing years. In this review, the place of leflunomide in therapy is discussed and practical advice informed by evidence is given regarding dosing regimens, safety monitoring, and managing side effects. Leflunomide remains one of the most useful of the nonbiologic DMARDs.Keywords: evidence-based practice, review, disease-modifying antirheumatic drugs, safety, efficacy, leflunomide, rheumatoid arthritis, psoriatic arthritis Peter BB JonesDouglas HN WhiteDove Medical PressarticleDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol 2010, Iss default, Pp 53-71 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the musculoskeletal system RC925-935
spellingShingle	Diseases of the musculoskeletal system RC925-935 Peter BB Jones Douglas HN White Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
description	Peter BB Jones1,2, Douglas HN White21Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 2Rheumatology Department, Waikato Hospital, Hamilton, New ZealandAbstract: Leflunomide is a disease-modifying antirheumatic drug (DMARD) that has been in routine clinical use for the treatment of rheumatoid arthritis (RA) and psoriatic arthritis for a decade. In RA, clinical trials of up to two years&rsquo; duration showed that leflunomide monotherapy was equivalent to methotrexate in clinical and radiographic disease outcomes (tender and swollen joint counts, physician and patient global assessments, American College of Rheumatology and Disease Activity Score responses, slowing or halting of radiographic progression). In a number of studies, quality of life measurements indicated that leflunomide is superior to methotrexate. Leflunomide has been studied in combination with methotrexate and shows efficacy in patients only partly responsive to this agent. Recent trials have shown that leflunomide can be used safely with biologic DMARDs, including antitumor necrosis factor agents and rituximab as part of the treatment algorithm in place of methotrexate as a cotherapy. Leflunomide has demonstrated efficacy as a monotherapy in psoriatic arthritis, and it also has a beneficial effect in psoriasis. Postmarketing studies have shown that retention on treatment with leflunomide is equal to methotrexate and superior to other DMARDs. In general, its side effect profile is acceptable compared with other DMARDS, with nausea, diarrhea, and hair fall occurring commonly, but only rarely leading to discontinuation. Liver toxicity is the most significant problem in clinical use although it is uncommon. Peripheral neuropathy, hypertension, pneumonitis, and cytopenia occur more rarely. Leflunomide is contraindicated in pregnancy and should be used with caution in women during child-bearing years. In this review, the place of leflunomide in therapy is discussed and practical advice informed by evidence is given regarding dosing regimens, safety monitoring, and managing side effects. Leflunomide remains one of the most useful of the nonbiologic DMARDs.Keywords: evidence-based practice, review, disease-modifying antirheumatic drugs, safety, efficacy, leflunomide, rheumatoid arthritis, psoriatic arthritis
format	article
author	Peter BB Jones Douglas HN White
author_facet	Peter BB Jones Douglas HN White
author_sort	Peter BB Jones
title	Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
title_short	Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
title_full	Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
title_fullStr	Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
title_full_unstemmed	Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
title_sort	reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/7d7a87290fc4437c8b3c13f26dd4880b
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Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis

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