The results of the latest study demonstrated the effectiveness of Leflunomide (LEF) in arthritis patients with failed methotrexate response. The investigators found LEF to be devoid of serious adverse effects and it can be considered a reasonable and cost-effective treatment option before initiating biological therapy.

LEF is a conventional synthetic disease modifying anti-rheumatic drug (csDMARD) indicated for the treatment of rheumatoid arthritis (RA) but is not utilized properly for its treatment. With the increasing economic burden of biologic therapy, it becomes important to understand the real-time efficacy, safety and sustainability of LEF in RA patients with failed methotrexate. Morgan Schultz and his team carried out the study to evaluate the percentage of patients achieving relevant clinical response through the adequate trial of LEF.

The study included a retrospective analysis of a cohort with the patient self-reported data using standardised questionnaire. Descriptive statistics were used to examine data with a database multivariate logistic regression analysis to define predictors of LEF response.

Out of the total 2591 participants in the cohort, 1671 patients with confirmed LEF use were included, of which 249 were incident users. About 20% of incident users were found to accomplish or maintain low disease activity (DAS-28 < 3.2) at three months and 19% estimated to achieve a clinical response (DAS-28 decrease ≥1.2) at three months. 29% of incident users reported adverse effects (AEs), and after one year, 45% remained on LEF. In the 661 analyzable survey responses, 34% (39% response rate) reported achievement of "minimal or no joint symptoms". 55% reported AEs, of which nuisance (hair loss, nausea, stomach pain) AEs and diarrhoea were most common. 67% of responders discontinued LEF within one year.