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Leflunomide for treating rheumatoid arthritis
1Medicine, Chulalongkorn University Hospital, Division of Rheumatology, Department of Medicine, Chulalongkorn University Hospital, Rama IV Road, Pathumwan, Bangkok, Thailand, 10330. Manathip.O@chula.ac.th
The Cochrane Database of Systematic Reviews
|January 22, 2003
Summary
Leflunomide effectively treats rheumatoid arthritis, improving clinical outcomes and delaying progression compared to placebo. Its efficacy and adverse events are comparable to other DMARDs like SSZ and MTX.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory joint disease.
- Leflunomide, a pyrimidine synthesis inhibitor, offers a distinct mechanism of action compared to existing disease-modifying anti-rheumatic drugs (DMARDs).
Purpose of the Study:
- To evaluate the efficacy and toxicity of leflunomide in RA treatment.
- Comparison of leflunomide against placebo and other DMARDs.
Main Methods:
- Systematic review of randomized controlled trials up to December 2001.
- Searches conducted in MEDLINE, EMBASE, Current Contents, and Cochrane Controlled Trial Register.
- Data extraction and quality assessment by two independent reviewers.
Main Results:
- Leflunomide demonstrated a significant improvement in ACR20 criteria compared to placebo (28% absolute difference).
- Clinical outcomes improved with leflunomide versus placebo, comparable to SSZ and MTX.
- Adverse event withdrawal rates were higher with leflunomide than placebo but comparable to SSZ and MTX.
Conclusions:
- Leflunomide improves clinical outcomes and delays radiologic progression in RA patients compared to placebo.
- Efficacy and adverse events at 2 years are comparable to SSZ and MTX.
- Long-term efficacy and toxicity require further investigation.