Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Effectiveness of Leflunomide in Psoriatic Arthritis.
Asiri1, Alhussain, Thavaneswaran2, Arane, Chandran1, Vinod, Kalman-Lamb1, Gideon, Gladman2, Dafna D.
While the short term efficacy and safety of Leflunomide in psoriatic arthritis (PsA) was documented in a short term randomized controlled trial, its longterm effect and safety in "real life" clinical situation is not known. This study aimed to evaluate the effectiveness of Leflunomide alone and in combination with methotrexate in "real life" situation as well as their adverse effects.
At the PsA Clinic patients have been followed prospectively and are evaluated according to a standard protocol which includes a detailed clinical history including drug therapy, physical examination, laboratory and radiological assessments at regular intervals. All information is tracked on an oracle database. Leflunomide became available in 2002. PsA patients who received leflunomide alone and in combination with methotrexate were identified from the PsA clinic database. Effectiveness was defined by persistence on the medication, a >= 40% reduction in actively inflamed joint a >= 40% reduction in swollen joint count, and PASI50 and PASI75 response following treatment with leflunomide. Univariate and multivariate logistic regression analyses with stepwise selection were used for data analysis.
84 patients were identified in our cohort. 43 patients (50.6%) were on Leflunomide alone and 42 (49.4%) patients were on Leflunomide in combination with methotrexate. There were 38 females and 47 males with a mean age of 51.6 (12.6) and mean disease duration of 12.3 (9.1). The mean number (sd) of actively inflamed joints count was 16(12.9), swollen joint count was 5.4(5.8), damaged joint count was 12.3 (13.0) and the mean PASI score was 4.7(6.5). 30 patients discontinued leflunomide, 16 in the leflunomide alone group and 14 in those taking leflunomide and MTX. The main reasons for discontinuing the drug were toxicity, including diarrhea, alopecia, and renal toxicity. Of the 54 patients who continued the drug, 38% achieved a >= 40% reduction of actively inflamed joint count at 3 months, 48% at 6 months and 56% at 12 months. PASI50 was achieved by 27%, 28% and 38% at 3, 6 and 12 months, whereas PASI75 was achieved by 19% at 3 and 6 months and 32% at 12 months. No predictors were identified for the improvement in actively inflamed joint count. However, duration of PsA (OR 1.09 95% CI 1.00, 1.18, p=0.03) and the number of swollen joints (OR 1.35, 95% CI 1.00, 1.83, p=0.003) at baseline were predictive for improvement of the swollen joint count at 3 months. The number of swollen joints at baseline was also predictive for improvement at 12 months (OR 2.01 95% CI 1.23, 3.27, p=0.005). The use of concomitant MTX was predictive for achieving a PASI50 (OR 6.19 95% CI 1.20, 31.97) at 12 months.
Leflunomide eventually led to >= 40% reduction in tender and swollen joint counts in almost 50% of the patients by 1 year. Those also taking MTX were more likely to achieve a PASI50 response. There was no significant difference in side effects between the Leflunomide group and Leflunomide and Methotrexate group.
To cite this abstract, please use the following information:
Asiri, Alhussain, Thavaneswaran, Arane, Chandran, Vinod, Kalman-Lamb, Gideon, Gladman, Dafna D.; The Effectiveness of Leflunomide in Psoriatic Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1325