China 
Africa 
Explore chapters and articles related to this topic
Rheumatologic diseases and antiphospholipid syndrome
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Thomas J. Santoro, Michiyo Tomita, Alfonse T. Masi
Methotrexate is considered the “anchor” drug in the treatment of rheumatoid arthritis (RA). It is an abortifacient (16) that may induce a pattern of congenital abnormalities, referred to as the fetal aminopterin/methotrexate syndrome (17). This condition consists of growth retardation, and craniofacial, limb, and neurologic developmental anomalies, which may be dose dependent. In planning conception, it is important to realize that it takes approximately 20 weeks for cell-associated methotrexate to become undetectable (18). In contrast to methotrexate, there are minimal data on the effects of leflunomide on human pregnancy, and the FDA’s pregnancy category X classification of this small molecule is largely based on the drug’s known inhibitory effects on transcription and translation (19) and its demonstrated teratogenicity and embryotoxicity in animal reproductive studies. Woman who become pregnant while undergoing treatment with leflunomide are advised to reduce fetal exposure to the drug by undergoing cholestyramine elimination procedure. In a study of 64 pregnant women with RA who were treated with leflunomide during pregnancy (61 of whom received cholestyramine), no increase in adverse pregnancy outcomes was found relative to 108 pregnant women with RA not treated with leflunomide and 78 healthy pregnant women (20).
Treatment of Rheumatoid Arthritis
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Stuart Weisman, Arthur Kavanaugh
Leflunomide has also been evaluated as an add-on therapy in patients with active disease despite the use of methotrexate. In a study of 266 patients, the combination of leflunomide and methotrexate conferred a significant therapeutic advantage in patients who had active arthritis while on methotrexate alone.32 The ACR 20 response rate at 24 weeks was 46.2% in the leflunomide plus methotrexate group vs. 19.5% for the placebo plus methotrexate group. The combination was well tolerated. Two abstracts have reported on the efficacy and safety of the combination of leflunomide and infliximab in a small number of patients.33,34
Immune system modulators
Published in Gabriel Virella, Medical Immunology, 2019
Richard M. Silver, Stephen Elmore
This agent works to impair the de novo pathway of pyrimidine synthesis, specifically targeting and inhibiting dihydro-orotate dehydrogenase. Side effects of leflunomide are similar in nature to those appreciated with methotrexate but can be more prolonged due to the longer half-life of the medication. Other side effects include headache, dizziness, skin rash, and hypertension. In addition, leflunomide is also teratogenic. Leflunomide has found a role in the treatment of rheumatoid arthritis, with trials demonstrating that it has a similar efficacy as methotrexate and sulfasalazine. Other diseases where leflunomide has been used include psoriatic arthritis, juvenile idiopathic arthritis, and several forms of vasculitis.
Histone deacetylase inhibitors as a potential new treatment for psoriatic disease and other inflammatory conditions
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Jehan Mohammad Nazri, Katerina Oikonomopoulou, Elvin D. de Araujo, Dziyana Kraskouskaya, Patrick T. Gunning, Vinod Chandran
In most patients with severe psoriatic disease, conventional synthetic DMARDs [61] are generally prescribed as initial treatment to suppress inflammation by broad targeting of the immune system. Some examples are Methotrexate and Leflunomide; both are antimetabolites that can interfere with a cell’s normal metabolic function to interrupt cell cycle progression and growth. In a recent retrospective study, Methotrexate treatment response in psoriasis patients, as measured by PASI 75 response, improved from 22% at 3 months to 37.5% at 6 months and then 34% at 12 months [62]. Similarly, in an observational cohort study, Leflunomide showed improvements in almost 50% of patients after 12 months [63]. However, despite clinical success, DMARDs tend to pose adverse side effects in patients due to nonspecific targeting of the immune system. Among others, Methotrexate and Leflunomide often cause gastrointestinal distress, infections, and alopecia [8,18,19].
Updates in the diagnosis and management of Takayasu’s arteritis
Published in Postgraduate Medicine, 2023
Anupam Somashekar, Yiu Tak Leung
A recent meta-analysis reviewing conventional and biologic disease modifying anti-rheumatic drugs (DMARDs) in the treatment of Takayasu’s arteritis included 63 observational studies and 4 randomized control trials [64]. The data for the use of conventional DMARDs is primarily limited to observational studies. In a pooled analysis of two uncontrolled observational studies, methotrexate demonstrated partial clinical response in 50% of patients (total 34 patients), while a separate pooled analysis of two observational studies of patients treated with azathioprine demonstrated a partial clinical response in 84% of patients (total 22 patients) [64]. Leflunomide also was found to be effective, with 80% of patients demonstrating at least partial clinical response in a pooled analysis of 53 patients in uncontrolled observational studies. Another observational study of 10 patients treated with cyclophosphamide followed by methotrexate demonstrated a partial clinical response in 80% of patients, with a 50% relapse rate in the patients who completed the study [65]. Overall, combined analyses found leflunomide to be safer and more clinically effective than cyclophosphamide in direct comparisons [64]. When compared to methotrexate, leflunomide demonstrated similar clinical responses at 6 months, 9 months, and 12 months with similar frequency of relapse in a single observational study [66].
Efficacy and safety of leflunomide combined with corticosteroids for the treatment of IgA nephropathy: a Meta-analysis of randomized controlled trials
Published in Renal Failure, 2022
Overall, nineteen RCTs [16–34] including 1153 patients with IgAN were included in the meta-analysis. The characteristics of the included studies are shown in Table 1. All of the included studies were open-label and parallel-group RCTs performed in China. All of the RCTs included patients with biopsy-proved IgAN, with the duration of the disease varying between 3 months and 10 years. The sample sizes of the studies varied between 36 and 108, and the mean ages of the patients ranged between 32 and 43 years. The proportions of males varied between 42% and 72%. The dosages of leflunomide were maintained as 20 mg/day, with or without a loading dose of 40 or 50 mg/day in the first three days of the treatment. Prednisone was used in both the interventional and control groups, with a dosage of 0.5–1 mg/kg/day and tapered thereafter. The follow-up durations varied from 1 to 24 months. Supporting treatments such as ACEIs/ARBs were generally concurrently administered. In ten studies [19,21,24,26–30,32,33], the dosages of CS was equal between the combined and the control groups (studies with full-dose CS in the combined treatment), while in nine studies [16–18,20,22,23,25,31,34], the dosages of CS used in the combined therapy was lower than that of the control group (studies with reduced dose of CS in the combined treatment).