Leflunomide in the current treatment algorithm for rheumatoid arthritis

Authors: K. Pavelka;  L. Šedová
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 17, 2009, No. 4, p. 192-199.
Category: Overview Reports


In this review, the authors deal with the position of leflunomide in the treatment algorithm for rheumatoid arthritis (RA). The principles of a modern treatment in RA are mentioned in the introduction. These principles are primarily defined in the „Recommendations“ for the treatment of RA generated by European League Against Rheumatism (EULAR), American College of Rheumatology (ACR) and Czech Society for Rheumatology (CRS). The recommendations emphasize the necessity of early start of disease modifying antirheumatic drugs (DMARDs) treatment, often even prior to establishment of a definite diagnosis of RA. Administration of DMARDs should be flexible, the effective dose can be titrated, and in case of insufficient effect, adjustment of the treatment in three-month intervals is recommended. Combinations of synthetic DMARDs, as well as combinations of synthetic DMARDs with biologic agents are used. The aim of the treatment should be to achieve remission, cessation of radiographic progression, improvement of quality of life and maintenance of ability to work. Leflunomide has been at least as effective as methotrexate (MTX) and sulfasalazine in clinical trials. In the ACR recommendations, leflunomide is regarded as the drug of first choice, equally with MTX, in active RA. CRS recommends MTX as the drug of first choice, and leflunomide as the drug of second choice, when MTX is not well tolerated or has an insufficient efficacy. Leflunomide can also be used in combination both with synthetic DMARDs and biological agents in RA. Although the combination of MTX and leflunomide is not stated in the SPC of the drug, however, based on the analysis of available data and one‘s own experience, ACR and ČRS recommend the combination of MTX and leflunomide providing a selection of suitable patients and a correct safety monitoring. The combination of leflunomide with biologic agents has been assessed in several randomized controlled trials, and several observational studies and registries. The majority of evidence suggests a comparable efficacy of the combination of MTX + biological agent and the combination of leflunomide + biological agent.

Key words:
rheumatoid arthritis, leflunomide


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Dermatology & STDs Paediatric rheumatology Rheumatology
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