Monitoring of Peripheral Blood Leukocytes and Plasma Samples: A Pilot Study to Examine Treatment Response to Leflunomide in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a painful inflammatory disease of the joints which affects a considerable proportion of the world population, mostly women. If not adequately treated, RA patients can become permanently disabled. Importantly, not all the patients respond to the available anti-rheumatic therapies, which also present diverse side effects. In this context, monitoring of treatment response is pivotal to avoid unnecessary side effects and costs towards an ineffective therapy. Herein, we performed a pilot study to investigate the potential use of flow cytometry and attenuated total reflection–Fourier transform infrared (ATR-FTIR) spectroscopy as measures to identify responders and non-responders to leflunomide, a disease-modifying drug used in the treatment of RA patients. The evaluation of peripheral blood CD62L+ polymorphonuclear cell numbers and ATR-FTIR vibrational modes in plasma were able to discriminate responders to leflunomide (LFN) three-months after therapy has started. Overall, the results indicate that both flow cytometry and ATR-FTIR can potentially be employed as additional measures to monitor early treatment response to LFN in RA patients.

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“…The principal unfavorable events in the medical trials blanketed gastrointestinal signs (diarrhoea, dyspepsia, nausea, abdominal ache, oral ulcers), accelerated liver function checks, skin rash/allergic reactions, alopecia, infections, weight loss, and hypertension. Only GI symptoms, alopecia, and high blood pressure have been determined to be considerably more within the leflunomide institution as compared to MTX 26 .…”

“…If the dose of 20 mg/day is not properly tolerated, then the dosage is reduced to 10 mg/day. Dosages more than 20 mg/day aren't encouraged 26,27 .…”