Adherence to Leflunomide (Arava) Might Improve With Lower Starting Dose

December 22, 2003

Adherence to Leflunomide Might Improve With Lower Starting Dose

Arthritis Care and Research 2003;49:745-751.

NEW YORK (Reuters Health) Dec 18 - Leflunomide appears to be a

relatively safe treatment for patients with rheumatoid arthritis (RA),

new research indicates. However, many patients discontinue therapy when

the drug is given at its recommended loading dose.

" Our data suggest that by starting on a lower dose initially, patients

tolerate the drug better, " study author Dr. Seth Eisen, from the VA

Medical Center in St. Louis, said in a statement. " The disadvantage is

that it may take a little bit longer for patients to improve clinically;

the advantage is that patients may be more likely to continue treatment. "

The new findings stem from a study of leflunomide use in the first 33

months after its approval by the US Food and Drug Administration in

October 1998. The report, which is based on data from 3325 veterans, is

published in the December 15th issue of Arthritis and Rheumatism.

Leflunomide was given at the recommended loading dose of 100 mg per day

for 3 days in 61% of subjects, the researchers report.

Forty-two percent of subjects stopped taking leflunomide, with a median

time to discontinuation of 17.6 months. Predictors of discontinuation

included receiving the recommended loading dose, age younger than 44

years or older than 75 years, and a family income of less than $60,000,

the authors note.

Review of medical records from 291 patients who discontinued leflunomide

revealed that most patients stopped the drug either because of

inefficacy (30%) or gastrointestinal symptoms (29%). Only 5% of subjects

stopped taking the drug because of elevated liver enzymes.

" As far as we could tell there were no surprises in terms of toxicity, "

Dr. Eisen noted. " Sometimes it takes a lot more patients than the 3300

we studied to pick up rare adverse events, but I think our findings are

reassuring to the large community of patients and clinicians. "

Recommended Posts