The influence of previous and concomitant leflunomide on the efficacy and safety of infliximab therapy in patients with rheumatoid arthritis; a longitudinal observational study

Flendrie, Marcel; Creemers, M.C.W.; Welsing, P.M.; Riel, P.L.C.M. van

doi:10.1093/rheumatology/keh508

Cited by 38 publications

(19 citation statements)

References 19 publications

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“…Two studies have found similar efficacy, whether measured using DAS28, American College of Rheumatology scores or treatment persistence, between anti-TNF in combination with either MTX or LEF 7 8. A further Dutch study (n=162), which compared anti-TNF persistence between those receiving LEF and those receiving any other DMARD(s), also found similar outcomes 28. In contrast Strangfeld et al 9 reported higher discontinuation rates of anti-TNF therapies (especially with INF) (n=1769) when combined with LEF than when combined with MTX, although this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 89%

Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register

et al. 2011

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ObjectiveTo evaluate the effect of different concomitant disease modifying antirheumatic drugs (DMARDs) on the persistence with antitumour necrosis factor (anti-TNF) therapies in patients with rheumatoid arthritis (RA).MethodThis analysis included 10 396 patients with RA registered with the British Society for Rheumatology Biologics Register, a prospective observational cohort study, who were starting their first anti-TNF therapy and were receiving one of the following DMARD treatments at baseline: no DMARD (n=3339), methotrexate (MTX) (n=4418), leflunomide (LEF) (n=610), sulfasalazine (SSZ) (n=308), MTX+SSZ (n=902), MTX+ hydroxychloroquine (HCQ) (n=401) or MTX+SSZ+HCQ (n=418). Kaplan–Meier survival analysis was used to study the persistence with anti-TNF therapy in each DMARD subgroup up to 5 years. Multivariate Cox proportional hazard models, stratified by anti-TNF used and start year and adjusted for a number of potential confounders, were used to compare treatment persistence overall and according to the reason for discontinuation between each of the DMARD subgroups, using MTX as reference.ResultsOne-year drug survival (95% CI) for the first anti-TNF therapy was 71% (71% to 72%) but this dropped to 42% (41% to 43%) at 5 years. Compared with MTX, patients receiving no DMARD, LEF or SSZ were more likely to discontinue their first anti-TNF therapy while patients receiving MTX in combination with other DMARDs showed better treatment persistence.ConclusionsThese results support the continued use of background DMARD combinations which include MTX. Consideration should be given to the discontinuation of LEF and SSZ monotherapy at the time anti-TNF therapies are started, with the possible exception of the SSZ+ETN combination.

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Section: Discussionmentioning

confidence: 89%

Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register

et al. 2011

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“…Leflunomide has been used in combination with biologicals, but the sample size of the studies are small, none were placebo controlled and different outcome measures were used [59][60][61][62][63].…”

Section: Clinical Efficacy N Rheumatology: Rheumatoid Arthritismentioning

confidence: 99%

Leflunomide: A Drug with a Potential Beyond Rheumatology

Teschner¹,

Burst

2010

Immunotherapy

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Leflunomide, an inhibitor of the dihydroorotase dehydrogenase and thereby pyrimidine synthesis, was introduced and licensed for the treatment of rheumatoid arthritis in 1998. In the following years, its antiviral properties were discovered and the drug was used in solid organ transplantation for polyomavirus type BK or cytomegalovirus infection. Owing to its long half-life and weak interaction with the cytochrome system, special considerations apply in the use of this drug. This article summarizes the clinical experience with leflunomide in rheumatology and in the evolving field of transplantation.

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“…Ком-бинация ЛФ и БП обеспечивала резкое повышение эффе-ктивности по сравнению с монотерапией. При этом пере-носимость лечения была примерно такой же, как и при использовании каждого препарата по отдельности [44][45][46][47]. В то же время одномоментное назначение ЛФ и БП сопровождалось повышением частоты нежелательных явлений [48].…”

Section: гу институт ревматологии рамн москваunclassified

Leflunomide in complex treatment for rheumatoid arthritis

Olyunin¹

2008

Modern Rheumatology Journal

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The influence of previous and concomitant leflunomide on the efficacy and safety of infliximab therapy in patients with rheumatoid arthritis; a longitudinal observational study

Abstract: The results indicate that the administration of infliximab after or simultaneously with leflunomide is safe and efficacious in RA patients.

Cited by 38 publications

References 19 publications

Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register

Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register

Leflunomide: A Drug with a Potential Beyond Rheumatology

Leflunomide in complex treatment for rheumatoid arthritis

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