RESEARCH - The effectiveness of Arava (leflunomide) as co-therapy of TNF inhibitors in RA

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Ann Rheum Dis. 2008 Jan 29 [Epub ahead of print]

The effectiveness of leflunomide as co-therapy of TNF inhibitors in

rheumatoid arthritis. A population based study.

Finckh A, Dehler S, Gabay C.

Geneva University Hospital, Switzerland.

BACKGROUND: Randomized trials have demonstrated that the efficacy of

anti-TNF agents is significantly increased by concomitant methotrexate

(MTX) in rheumatoid arthritis (RA). In clinical routine, anti-TNF

agents are commonly prescribed with other disease modifying

antirheumatic drugs (DMARDs) than MTX, however their effectiveness in

combination with anti-TNF agents is not well established. OBJECTIVE:

To compare the effectiveness of leflunomide (LEF) and other

conventional DMARDs with MTX as co-therapy to anti-TNF agents in RA.

METHODS: All patients on anti-TNF agents and conventional DMARDs

within the SCQM-RA database were included (N=1218) and categorized

according to the type of co-therapy into anti-TNF+MTX (N=842),

anti-TNF+LEF (N=260) and anti-TNF+other DMARDs (N=116). Drug

discontinuation rates and incidence of toxic side effects were

analyzed using proportional hazards models. Progression of

radiographic damage, the evolution of functional disability and the

improvement of RA disease activity were analyzed using longitudinal

regression models, adjusting for potential confounders. RESULTS: The

overall discontinuation rates of anti-TNF and conventional DMARD

combination therapies were relatively high with a median survival of

only 16 months (IQR: 10 - 37), but they did not differ between the

three regimen (p=0.69). The progression of radiographic damage

(p=0.77), functional disability (p=0.09) and RA disease activity

(p=0.33) were also similar between the different regimen. In addition,

no significant difference in the frequency of adverse events emerged.

CONCLUSION: Overall these results suggest that LEF and potentially

other conventional DMARDs offer an effective and safe alternative to

MTX as co-therapy in combination with anti-TNF agents.

PMID: 18230627

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=182306\

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