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Lupus erythematosus with leflunomide: induction or reactivation?
D Gensburger1, M Kawashima, H Marotte
1Department of Immunology, Hôpital Edouard Hérriot, 69437 Lyon Cedex 03, France.
Annals of the Rheumatic Diseases
|December 21, 2004
Summary
Leflunomide, an antirheumatic drug, may induce lupus erythematosus in some patients. This side effect, linked to Th1/Th2 balance alteration, highlights a potential risk associated with leflunomide treatment.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Leflunomide is an oral disease-modifying antirheumatic drug (DMARD) known for its favorable safety profile.
- It is commonly prescribed for autoimmune conditions like rheumatoid arthritis and Sjögren's syndrome.
Observation:
- A case report details a 58-year-old woman who developed lupus erythematosus after starting leflunomide for primary Sjögren's syndrome.
- The drug-induced lupus was confirmed by the disappearance of skin rash upon leflunomide cessation and its reappearance upon reintroduction, demonstrating a dose-response relationship.
Findings:
- Bioassays using patient peripheral blood cells indicated that leflunomide influences the Th1/Th2 immune cell balance.
- This immunomodulatory effect may contribute to the development of lupus erythematosus as an adverse event.
Implications:
- The findings suggest a potential mechanism for leflunomide-induced lupus, involving the drug's impact on cytokine profiles.
- This highlights the importance of monitoring for autoimmune side effects in patients receiving leflunomide, particularly those with pre-existing autoimmune tendencies.