Treatments combining leflunomide (Arava) with an antitumor necrosis factor (TNF) agent were as effective in rheumatoid arthritis as regimens combining methotrexate with the biologics, a randomized Italian study found.
After 24 weeks of therapy, patients receiving a methotrexate-based regimen achieved a mean Disease Activity Score (DAS)28 of 3.3, while those receiving leflunomide-based treatment had a mean DAS28 of 3.5, according to Renato De Stefano, MD, and colleagues from the Siena (Italy) University Hospital.
Remission was achieved by 21.6% of patients in the methotrexate group and 16.6% of those in the leflunomide group. Neither of these differences was statistically significant, the investigators reported online in Clinical Rheumatology.
Multiple clinical trials have now demonstrated the efficacy of TNF blocking agents in combination with methotrexate for rheumatoid arthritis, but some patients can't tolerate or don't respond to methotrexate.
Some data suggested leflunomide as an alternative to methotrexate, particularly if the TNF blocker is not begun for at least 12 weeks after the initiation of leflunomide.
http://www.medpagetoday.com/Rheumatology/Arthritis/18231