Methotrexate and leflunomide in combo?

[Guest guest]

Hi,

My specialist has just suggested I start taking leflunomide (Arava) at 10mg per

day

(without a loading dose) in combination with methotrexate at 20mg/week, which

I've been

taking for a few years now. The methotrexate had been working for me quite well

(although I had one episode of raised LFTs and had to stop taking it for a

while), but this

year things have been getting worse, with pain in my shoulders and neck for the

first time.

Prior to that, it was mainly hands, feet and knees (I already had one

replacement knee

joint) that were suffering.

Anyway, I got the first batch of leflunomide and the thing I saw in the

information leaflet

was that it wasn't recommended to take it with methotrexate. We did a Google

search and

found that there has been a clinical trial of these two drugs in combination,

with a

conclusion that it was notably effective for a number of patients and deemed

'safe'. But

details in that trial report, and other information we found, did also say that

the possible

side effects of leflunomide include some that are quite alarming! Not least were

mentions

of the (remote) possibility of some sort of skin necrosis and the fact that

leflunomide is

quite possible (or likely?) to be carcinogenic.

The Wikipedia entry on leflunomide seemed quite 'interesting':

<http://en.wikipedia.org/wiki/Leflunomide>

I'm wondering if there's anyone here who's taking methotrexate and leflunomide

in

combination and, if so, how do (did) you get on with it? At the moment, I'm

feeling more

than a little reluctant to start taking the leflunomide, after the information

I've seen about

it, I must say. It's certainly making me wonder what alternatives I might

consider.

Oh, and the thing I'm most annoyed about is that the specialist didn't really

explain that

much at all about these side effects (other than the need to have regular blood

tests to

check LFTs, but I'm already used to those!), which I think was a bad omission on

his part.

Perhaps that's down to the patronising attitude that our doctors have here in

the UK,

however wonderful our NHS may otherwise be!

Annette

[Guest guest]

I also was not willing to take both

Methotrexate and Arava at the same time because of possible damage to

liver. However, I do know someone who has his RA controlled much better

by taking the combination and is very pleased with it. The side effects,

though possible, are not likely and most are resolved by stopping the

medication.

As far as the doctors not explaining side

effects of medications, that is generally true in the US also.

They count on the information sheet that comes with the medication and the

pharmacist (that might be chemist in UK) who dispenses it. I’m

currently doing quite well on Methotrexate plus Remicade. I hope you get

relief some way. God bless.

From:

Rheumatoid Arthritis

[mailto:Rheumatoid Arthritis ] On

Behalf Of w1nst0nbear

Sent: Tuesday, October 03, 2006

1:47 PM

To:

Rheumatoid Arthritis

Subject:

Methotrexate and leflunomide in combo?

Hi,

My specialist has just suggested I start taking leflunomide (Arava) at 10mg per

day

(without a loading dose) in combination with methotrexate at 20mg/week, which

I've been

taking for a few years now. The methotrexate had been working for me quite well

(although I had one episode of raised LFTs and had to stop taking it for a

while), but this

year things have been getting worse, with pain in my shoulders and neck for the

first time.

Prior to that, it was mainly hands, feet and knees (I already had one

replacement knee

joint) that were suffering.

Anyway, I got the first batch of leflunomide and the thing I saw in the

information leaflet

was that it wasn't recommended to take it with methotrexate. We did a Google

search and

found that there has been a clinical trial of these two drugs in combination,

with a

conclusion that it was notably effective for a number of patients and deemed

'safe'. But

details in that trial report, and other information we found, did also say that

the possible

side effects of leflunomide include some that are quite alarming! Not least

were mentions

of the (remote) possibility of some sort of skin necrosis and the fact that

leflunomide is

quite possible (or likely?) to be carcinogenic.

The Wikipedia entry on leflunomide seemed quite 'interesting':

<http://en.wikipedia.org/wiki/Leflunomide>

I'm wondering if there's anyone here who's taking methotrexate and leflunomide

in

combination and, if so, how do (did) you get on with it? At the moment, I'm

feeling more

than a little reluctant to start taking the leflunomide, after the information

I've seen about

it, I must say. It's certainly making me wonder what alternatives I might

consider.

Oh, and the thing I'm most annoyed about is that the specialist didn't really

explain that

much at all about these side effects (other than the need to have regular blood

tests to

check LFTs, but I'm already used to those!), which I think was a bad omission

on his part.

Perhaps that's down to the patronising attitude that our doctors have here in

the UK,

however wonderful our NHS may otherwise be!

Annette

[Guest guest]

Hi,

Thanks for the reply. I saw my GP yesterday and with his advice, I've decided to

go back to

the specialist to discuss other alternatives to the Arava, especially as I'm

already also taking

plaquenil.

I'm new to this group and have found it very interesting and helpful.

Annette

--- In Rheumatoid Arthritis , " Harold Van Tuyl " <hvantuyl@...>

wrote:

>

> I also was not willing to take both Methotrexate and Arava at the same time

> because of possible damage to liver. However, I do know someone who has his

> RA controlled much better by taking the combination and is very pleased with

> it. The side effects, though possible, are not likely and most are resolved

> by stopping the medication.