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Leflunomide-associated pancytopenia with or without methotrexate
Jonathan Chan1, Daniela C Sanders, Leanne Du
1Department of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
The Annals of Pharmacotherapy
|June 10, 2004
Summary
Leflunomide can cause severe pancytopenia, especially when combined with methotrexate in older patients. Vigilance and monitoring are crucial due to variable onset times and potential for serious outcomes.
Area of Science:
- Rheumatology
- Clinical Pharmacology
- Hematology
Background:
- Leflunomide is an immunosuppressive drug commonly used for rheumatoid arthritis.
- It functions by inhibiting pyrimidine synthesis in rapidly dividing cells.
Observation:
- This study reports 18 cases of pancytopenia associated with leflunomide use in Australia.
- The median age of affected patients was 65.5 years, with 15 females.
- Fourteen patients were on combined therapy with methotrexate.
Findings:
- Pancytopenia was often severe, necessitating hospitalization, drug withdrawal, and intensive supportive care.
- Five patients died, four of whom were on concomitant methotrexate.
- Onset of pancytopenia ranged from 11 days to 4 years, with a median of 4 months.
Implications:
- Combination therapy with methotrexate may increase the risk of leflunomide-induced pancytopenia.
- Older patients and those experiencing changes in health status require heightened monitoring.
- Clinicians must remain vigilant for pancytopenia during leflunomide therapy, especially with co-medications.