Systematic review and meta-analysis of the efficacy and safety of leflunomide and methotrexate in the treatment of rheumatoid arthritis

Alfaro-Lara, Roberto; Espinosa-Ortega, Fabricio; Arce-Salinas, César Alejandro

doi:10.1016/j.reumae.2017.07.011

Cited by 12 publications

(12 citation statements)

References 32 publications

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“…Similar improvements have been previously reported . Alfaro‐Lara and his colleagues compared the efficacy and safety of leflunomide and MTX, and put forward that leflunomide was as efficacious as MTX in treatment of rheumatoid arthritis …”

Section: Discussionsupporting

confidence: 78%

Efficacy and safety of leflunomide in psoriatic arthritis treatment: A single‐arm meta‐analysis

Dai

2019

Int J of Rheum Dis

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Aim:To systematically assess the clinical efficacy and safety of leflunomide for treating psoriatic arthritis (PsA).Methods: PubMed, Embase, and Cochrane Library databases were searched until 1 January, 2018, to include relevant studies in this single-arm meta-analysis. Psoriasis improvement was evaluated using Psoriasis Area and Severity Index (PASI) scores.The primary outcome in patients was assessed using the Psoriatic Arthritis Response Criteria (PsARC). Other effectiveness evaluations included those of adverse events, quality of life including functional status (Health Assessment Questionnaire [HAQ] total score), and a quality-of-life instrument for dermatologic diseases (Dermatology Life Quality Index [DLQI] total score). Results:A total of 6 studies were included. After leflunomide treatment, 48% of the patients experienced a reduction of ≥50% based on PASI scores (95% confidence interval [CI]: 0.22-0.73). PASI 75 improvement was observed among 25% of the patients (95% CI: 0.11-0.38). The primary effectiveness analysis revealed that 15% of the patients (95% CI: 0.07-0.26) discontinued leflunomide treatment. Further, 77% of the patients (95% CI: 0.59-0.92) achieved a PsARC response. Adverse events occurred in 38% of the patients (95% CI: 0.04-0.71). The mean ± SD percentage PASI improvement was −4.88 (95% CI: −8.92, −0.85). Moreover, DLQI and HAQ were −2.02 (95% CI: −3.01, −1.03) and −0.19 (95% CI: −0.29, −0.09), respectively. Conclusions:Leflunomide is an effective and well-tolerated treatment for PsA, and would be a safe and convenient option. K E Y W O R D Sleflunomide, meta-analysis, psoriatic arthritis

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Section: Discussionsupporting

confidence: 78%

Efficacy and safety of leflunomide in psoriatic arthritis treatment: A single‐arm meta‐analysis

Dai

2019

Int J of Rheum Dis

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“…The Step-Up with LEF in patients with RA is a valid strategy to scale up treatment in non-responders to MTX, but the evidence we have is scarce [20,[22][23][24]. The few randomized clinical trials (RCTs) that analyzed it, do not use strict response measures such as referral by DAS28; they also do not have patients with early RA as a study population.…”

Section: Discussionmentioning

confidence: 99%

Metothrexate Plus Leflunomide Step-Up Therapy in Early Rheumatoid Arthritis Patients with Non-Response to Initial Methotrexate Monotherapy

Carlevaris¹,

Citera²,

Pellet³

et al. 2019

Rheumatology

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Methods: We included a cohort of patients with diagnosis of early RA of less than 2 years of disease duration who not respond to MTX monotherapy, according to medical judgment, and added step-up combination with LEF. Data were collected every 3 months, including sociodemographic characteristics, functional status, disease activity and treatment. The primary outcome was the time to remission with the combined therapy, defined according to disease activity index of 28 joints (DAS28). Combination treatment failure was defined as not achieving remission. Time of outcome was assessed from date of the start of MTX plus LEF combination to date of remission or last follow-up. The Kaplan-Meier product limit method was used to estimate the probability of each outcome. Results: A total of 106 patients were included. The median disease duration was 4 (IQR 2-8) months. Median followup was 34 ± 18 months (300 patients-year). Mean age was 50 ± 12 years and 83% were female. At the time of LEF addition, 95 (90%) of patients were not in remission. During follow-up, 47 (50%) achieved clinical remission at a median time of 8 months. The rest of the patients failed to achieve remission. The overall probability of remission per patients-months of follow-up was 0.49. Twenty seven out of 47 patients (58%) were still in remission at the last follow up visit (median follow-up after first remission=19 months).

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“…Methotrexate (MTX) is a typical DMARD. It is an effective drug with a reasonable price and acceptable side effects (12,13), and is thus widely used in the treatment of RA. Taken orally, MTX can be basically eliminated within 24 hours.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis on the efficacy of methotrexate in rheumatoid arthritis

Jiang

Jin

Chen³

et al. 2021

Ann Palliat Med

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Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease dominated by chronic inflammation of the synovium of the joints. Methotrexate (MTX) is the most widely used in the treatment of RA. This study systematically evaluated the clinical efficacy of MTX on RA and provided a theoretical basis for the clinical treatment of RA.Methods: Four English databases (PubMed, Embase, Medline, and Web of Sciences) were searched for randomized controlled trials (RCTs) on MTX treatment of RA published from the date of establishment of the database to 2021. The Cochrane Handbook 5.0.2 was used to perform risk bias evaluation and Review Manager 5.3 was used to conduct a meta-analysis.Results: A total of eight articles were included. The meta-analysis showed that, compared to the control group, the number of patients with DAS28-ESR ≤2.6 [erythrocyte sedimentation rate (ESR)] in the MTX alone or MTX combined treatment groups was higher, and the incidence of adverse events was also higher.However, there was no significant difference in the level of alanine aminotransferase (ALT) after treatment versus the control group.Discussion: MTX alone or MTX combined treatment can better control the condition of RA patients without causing damage to the patient's blood system or liver and kidney function, but may increase the probability of adverse events.

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Systematic review and meta-analysis of the efficacy and safety of leflunomide and methotrexate in the treatment of rheumatoid arthritis

Cited by 12 publications

References 32 publications

Efficacy and safety of leflunomide in psoriatic arthritis treatment: A single‐arm meta‐analysis

Efficacy and safety of leflunomide in psoriatic arthritis treatment: A single‐arm meta‐analysis

Metothrexate Plus Leflunomide Step-Up Therapy in Early Rheumatoid Arthritis Patients with Non-Response to Initial Methotrexate Monotherapy

Systematic review and meta-analysis on the efficacy of methotrexate in rheumatoid arthritis

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