Leflunomide in Psoriatic Arthritis

Behrens F, et al. Leflunomide in psoriatic arthritis: Results from a large European prospective observational study. Arthritis Care Res. 2013 Mar;65(3):464-470. doi: 10.1002/acr.21848.

A total of 514 patients were enrolled in this study (mean age 50.7 years, mean disease duration 6.1 years). In the primary effectiveness analysis, 380 (86.4%) of 440 patients (95% confidence interval 82.8%–89.4%) achieved a PsARC response at 24 weeks. Significant improvements were observed in tender and swollen joint scores and counts, patient and physician global assessments, fatigue, pain, skin disease, dactylitis, and nail lesions.

This was a prospective observational trial with a large number of patients, and provides additional necessary evidence that leflunomide is effective in psoriatic arthritis.

The most frequent ADRs were diarrhea (16.3% of all ADRs), alopecia (9.2%), hypertension (8.2%), and pruritus (5.1%).

The discontinuation rate was 12.3%. Ninety-eight adverse drug reactions occurred in 62 (12.1%) patients; 3 drug reactions were serious (2 increased liver enzymes, 1 hypertensive crisis).

Here, I just want to point out that leflunomide has been known to cause hypertension. Something we should watch for.

There is evidence that adding leflunomide to concomitant DMARD therapy did not lead to an increase in adverse events

Leflunomide might be a nice option to add to patients already on anti-TNF monotherapy with uncontrolled disease.