Effect of Hemodialysis on Leflunomide Plasma Concentrations

Use of etanercept in a patient with rheumatoid arthritis on hemodialysis

“…But these drugs can easily be eliminated by HD when they are used in smaller doses, and there have been reports that RA patients on HD were responsive to them in small doses [6][7][8][9] Leflunomide is excreted in bile, and clearance is not influenced by renal function. Dose reductions do not appear to be required for patients on HD [10]. Tacrolimus is also excreted in bile, and clearance is not influenced by renal function [11], but some reports have described some nephrotoxicity for tacrolimus [12].…”

Efficacy and safety of tacrolimus treatment for rheumatoid arthritis patients undergoing hemodialysis

“…On the other hand, leflunomide which was approved as one of the DMARDs in 2003 may be used in patients on hemodialysis without a reduction of the dose [2,3]. However, cases of the death by interstitial pneumonia were reported in succession in the several years after leflunomide became available in Japan, and therefore its use tends to be limited.…”

“…It is considered that leflunomide and etanercept can be administered regardless of renal function based on their pharmacokinetics [2][3][4]. However, there are very few clinical reports demonstrating that these drugs are safe, well tolerated, and effective in patients with renal failure.…”

Leflunomide an Immunosuppressive Drug for Antiviral Purpose in Treatment for BK Virus-Associated Nephropathy After Kidney Transplantation

“…Elimination of A77 1726 is slow, it is characterized by an apparent clearance of 0.051 L/h (Rozman 2002). This elimination is mostly renal (43%) and biliary (48%), as a consequence renal insufficiency alone does not significantly impair A77 1726 plasma concentrations (Beaman et al 2002). Furthermore haemodialysis does not modify concentrations or clearance of A77 1726, which allows the patients to be on a dialysis without any dose adjustment.…”