Survival and effectiveness of Arava compared with MTX and sulfasalazine in RA

[Guest guest]

ls of the Rheumatic Diseases 2003;62:944-951

© 2003 by BMJ Publishing Group & European League Against Rheumatism

------------------------------------------------------------------------

EXTENDED REPORT

Survival and effectiveness of leflunomide compared with methotrexate and

sulfasalazine in rheumatoid arthritis: a matched observational study

D Aletaha1, T Stamm1, T Kapral1, G Eberl2, J Grisar1, K P Machold1 and J

S Smolen1,2

1 Division of Rheumatology, Department of Internal Medicine III,

University of Vienna, Austria

2 Second Department of Medicine, Lainz Hospital, Vienna, Austria

Correspondence to:

Dr D Aletaha, Division of Rheumatology, Department of Internal Medicine

III, University of Vienna, Vienna General Hospital, Waehringer Guertel

18-20, A-1090 Vienna, Austria;

daniel.aletaha@...

Objective: To determine the survival and clinical effectiveness of

leflunomide (LEF) compared with methotrexate (MTX) and sulfasalazine

(SSZ) for RA in an observational study.

Methods: An observational database of 1088 patients and 5141 patient

years of DMARD treatment (2680 courses) from two academic hospitals was

filtered for treatment with LEF, MTX, and SSZ. LEF treatment groups were

matched for patients' age, baseline ESR, number of previous DMARDs, and

hospital cohort with MTX and SSZ treatment groups. For these treatments,

Kaplan-Meier analyses of time until the drug was discontinued (drug

" survival " ), and the effectiveness and safety of continuation of

treatment, were performed. The change in disease activity markers (CRP,

ESR) was compared between the groups.

Results: The median dose during the study increased from 10 to 15 mg

MTX/week and from 1.5 to 2.0 g SSZ/day. Matched survival analysis showed

better retention rates for MTX (mean (SEM) survival 28 (1) months) than

for LEF (20 (1) months; p=0.001), whereas retention rates of SSZ (23 (1)

months) were similar to those of LEF (p=NS). Treatments were stopped

earlier because of adverse events (AEs, 3 months) than because of

ineffectiveness (IE, 10 months; p<0.001). LEF and MTX were less likely

to be stopped because of AEs than SSZ. LEF courses were stopped earlier

for AEs (p<0.001) than MTX.

CONCLUSIONS: Current dosing strategies should be re-evaluated, and

coping strategies for common AEs should be investigated. This will be

necessary to achieve better drug retention of LEF. At present, MTX

continues to be the most effective drug in clinical practice.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org