Multicenter audit on the use of Leflunomide, in isolation or combination and assessment of adverse effects in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is a highly prevalent condition worldwide with significant associated morbidity and disability. In recent decades, disease modifying anti-rheumatic drugs (DMARDs) have been employed as mono or combination therapy to halt disease progression and the sequelaefrom occurring. Due to immunomodulatory effects, the frequency of monitoring adverse effects and termination of medication has long been under scrutiny.AimThis multicentre audit considered Leflunomide use in clinical practice. Factors considered include the underlying condition treated, starting and maintenance doses, whether it was a mono or combination therapy, side effects reported and monitoring conducted.MethodsA retrospective review of case-notes from Leflunomide-treated patients was conducted at three centres in the UK. A pre-agreed proforma was completed to collect data appropriate to each aim.ResultsFour hundred and twenty-seven case-notes were reviewed. Over 95% of patients received it for RA, 20 mg was the commonest loading/maintenance dose and 80% were treated with Leflunomide as mono-therapy Gastrointestinal symptoms (18%) were the most prevalent side effects with most occurring within the first 6 weeks. A reduction in clinical efficacy was noted in 21% of patients. Monitoring varied significantly at each of the centre but little difference in the outcome was noted.ConclusionWhile DMARDs have become first-line treatmentsin RA, increasing evidence suggests that monitoring does not need to be as rigorous as previously believed. This audit highlights a relative advantagein using Leflunomide in terms of dosing, its use as a mono-or combination therapy, side effects, long-term tolerability and monitoring.