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Leflunomide And Methotrexate Equally Effective For Rheumatoid Arthritis
A DGReview of :"Toward a Definition and Method of Assessment of Treatment Failure and Treatment Effectiveness: The Case of Leflunomide versus Methotrexate"
Journal of Rheumatology
09/30/2003
By Mary Beth Nierengarten
Using an expanded definition of treatment failure to include both discontinuation of treatment or addition of a second disease modifying antirheumatic drug (DMARD), leflunomide and methotrexate were found to be equally effective in the treatment of rheumatoid arthritis.
Because of the potential for channelling bias as well as secular and cohort effects, a customary way of assessing treatment efficacy based on time to treatment discontinuation (TTD) does not always provide accurate assessment of the real efficacy of treatments.
In an attempt to provide a more comprehensive and more accurate assessment of treatment failure and efficacy, Federick Wolfe, MD, National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, United States, and colleagues developed a new definition of treatment failure to include both the discontinuation of treatment or the use of additional DMARs. They used this new definition in comparing the effectiveness of leflunomide (LEF) versus methotrexate (MTX) and to identify factors associated with treatment success or failure.
In their retrospective study, 1431 patients with rheumatoid arthritis, who had never received prior treatment with LEF or MTX, received LEF or MTX between 1998 and 2001 and were assessed every 6 months up to 36 months.
No statistically significant differences were found between the two treatment groups, with a median time to failure of 15 months for the 756 patients taking LEF and 14 months for 675 patients taking MTX. Overall, the rate of treatment discontinuation was 68.7% and was more common in the LEF-treated patients whereas the addition of a second DMARD was more common in the MTX-treated patients.
Based on these results, the authors conclude that treatment failure rather than treatment discontinuation is a more accurate description of treatment effect.
J Rheumatol 2003;30:1725-32.
"Toward a Definition and Method of Assessment of Treatment Failure and Treatment Effectiveness: The Case of Leflunomide versus Methotrexate"
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