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Leflunomide Once Weekly as Effective as Daily Regimen in Patients With Rheumatoid Arthritis
Journal of Rheumatology
06/23/2004
By Shane Alexander
A single dose of leflunomide 100 mg/week can be as effective as the traditional 20 mg/day regimen in patients with clinically active rheumatoid arthritis.
The progression of rheumatoid arthritis (RA) can be controlled by several disease modifying antirheumatic drugs (DMARDs) but only for a limited period of time, according to Jorge Jaimes-Hernandez, MD, and colleagues, Rheumatology Department, Internal Medicine Division, Centro Medico ISSEMyM, State of Mexico.
"Unfortunately, multiple drug intake, adverse gastrointestinal effects, and the cost of medication do not permit DMARD treatment of RA patients for long periods of time," write the authors. "Leflunomide (LFN), a recent clinically used DMARD in Mexico, is an isoxazol drug with antiproliferative and immunosuppression effect, and with a half-life of up to 15 to 18 days."
The investigators recruited 50 patients (46 women, mean age 45.6 years) for this 24-week open-label trial. Disease duration was less than 5 years for 76% of patients. Forty-eight percent of patients had been treated by DMARD prior to the study.
Researchers evaluated the efficacy of the treatment with the American College of Rheumatology (ACR) 20%, 50% and 70% improvement criteria, a visual analogue scale for pain, erythrocyte sedimentation count, liver enzymes and glucose at 0, 2, 4, and 6 months.
Patients received a loading dose of 100 mg/day of LFN for 3 days, followed by 100 mg of LFN once weekly until the end of the trial. Seventy-six percent of patients obtained an ACR 20 score and 58% an ACR 50 score after 12 weeks of treatment. At the end of the study (24 weeks), 74% of patients reached ACR 20, 64% reached ACR 50, and 28% reached ACR 70.
Headaches, hair loss and myalgias were reported by 16%, 10% and 10% of patients, respectively. Liver enzyme levels were abnormal in 10% of patients. One patient had severe thrombocytopaenia.
Analysis showed the improvement achieved with LFN 100 mg/week to be similar to that obtained with the usual 20 mg/day regimen. "Patients feel comfortable and have better compliance with the prescribed weekly treatment. Furthermore the monthly cost of medication is reduced," the researchers conclude.
J Rheumatol 2004 Feb;31:2:235-237
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