Leflunomide in Rheumatoid Arthritis: Effect on Laboratory Parameters
Keywords:
Rheumatoid arthritis, Leflunomide, Laboratory parameters, Drug response, Drug safetyAbstract
Objective: To evaluate the effect of leflunomide on laboratory parameters in patients of rheumatoid arthritis.
Materials and Methods: A 24-week, single-blind study was carried out on 158 consecutive patients, aged 29-70 years, diagnosed
with rheumatoid arthritis. They received tablet leflunomide 20 mg daily, orally. Laboratory tests were recorded at the initial
visit and follow-ups. Leflunomide has been known to bring about changes in various blood parameters like hemoglobin, total
white cell and platelet counts, erythrocyte sedimentation rate, serum creatinine and serum glutamic pyruvic transaminase levels.
All patients were subjected to these laboratory tests.
Results: At the end of the study at 24 weeks the hemoglobin was raised to 12.62 grams per deciliter (g/dl) from a baseline of
10.81 g/dl, white cell count fell to 6,728 per cubic mm (cmm) from 8,318 / cmm, the ESR fell to 39.01 millimeters of mercury
(mm of Hg) in 1st hour from 82.10 mm of Hg, the platelet count fell to 2,37,419 / cmm from 2, 96,166 / cmm, the SGPT levels
were raised to 38.01 international units per litre (IU/l) from 31.84 IU/l and the serum creatinine fell to 0.936 mg/dl from
0.937 mg/dl. All values, except serum creatinine, were found to be highly significant statistically (p<0.001).
Conclusion: Leflunomide showed significant effects on the laboratory parameters. These parameters may be utilized
in patients follow up to monitor the drug response and as a marker of drug safety of leflunomide
References
Allaire SH, Prashker MJ, Meenan RF. The costs of
rheumatoid arthritis. Pharmaco Economics. 1994; 6:513-
Del Puente A, Knowler WC, Pettit DJ, Bennett PH. High
incidence and prevalence of rheumatoid arthritis in Pima
Indians. Am J Epidemiol 1989; 129:1170-8
Akhter E, Bilal S, Kiani A, Haque U. Prevalence of arthritis
in India and Pakistan: a review. Rheumatol Int.
; 31(7):849-55
Hameed K, Gibson G, Kadir M. The prevalence of rheumatoid
arthritis in affluent and poor urban communities
of Pakistan. Br J Rheumatol 1995; 34:252-6
Pisetsky DS. Laboratory testing in the rheumatic diseases.
In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd
ed. Philadelphia, Pa: Saunders Elsevier: chap. 278;2007
Álvarez-Lafuente R, Fernández-Gutiérrez B, Miguel S
de, Jover JA, Rollin R, Loza E et al. Annals of the Rheumatic
Diseases 2005; 64:1357-9
Ferrell PB, Aitcheson CT, Pearson GR, Tan E.M. Seroepidemiological
study of relationships between Epstein-
Barr virus and rheumatoid arthritis. J Clin Invest 1981;
(3): 681-7
Catalano MA, Carson DA, Slovin SF, Richman DD,
Vaughan JH. . Proc. Natl. Acad. Sci. USA, Immunology
; 76 (11):5825-8
Balandraud N, Roudier J. Epstein-Barr virus and rheumatoid
arthritis. Autoimmunity Reviews 2004; 3(5):362-
Arnett FC, Edworthy SM, Bloch DA, McShane DJ,
Fries JF, Cooper NS, et al. Arthritis Rheum 1988; 31
(3): 315-24
Plant MJ, Saklatvala J, Borg AA, Jones PW, Dawes PT.
Measurement and prediction of radiological progression
in early rheumatoid arthritis. J Rheumatol 1994; 10:1808-
O'Dell J. Therapeutic strategies for rheumatoid arthritis.
N Engl J Med 2004; 350 (25): 2591-602
Hasler P. Biological therapies directed against cells in
autoimmune disease. Springer Semin Immunopathol
; 27 (4): 443-56
Ward MM, Fries JF. Trends in anti-rheumatic medication
use among patients with rheumatoid arthritis, 1981-
J Rheumatol 1998; 25:408-16
http://www.medicinenet.com/leflunomide/article.htm
Clinical pharmacokinetics of Leflunomide. 2002; 41(6):
-30
Davis JP, Cain GA, Pitts WJ, Magolda RL, Copeland
RA. The immunosuppressive metabolite of Leflunomide
is a potent inhibitor of human dihydroorotate dehydroge-
nase. Biochemistry 1996; 35:1270-3
Leflunomide monitoring guidelines 3, ebookbrowse,
Nemazee D, Hogquist KA. Antigen receptor selection
by editing or down regulation of V(D) J recombination.
Curr. Opin. Immunol 2003; 15: 182-9
Smolen JS, Kalden JR, Scott DL. European Leflunomide
Study Group. Efficacy and safety of Leflunomide
compared with placebo and sulphasalazine in active
rheumatoid arthritis: a double-blind, randomized, multicentre
trial. Lancet 1999; 353: 259-66
Ishaq M, Muhammad JS, Hameed K, Mirza AI. Leflunomide
or methotrexate? Comparison of clinical efficacy
and safety in low socio-economic rheumatoid arthritis
patients. Rheumatol 2011;21(4):375-80
Mehta V, Kisalay S, Balachandran C. Leflunomide. Indian
J Dermatol Venereol Leprol 2009; 75:422-4
Curtis JR, Beukelman T, Onofrei A, Cassell S, Greenberg
JD, Kavanaugh A et al. Elevated liver enzyme tests among
patients with rheumatoid arthritis or psoriatic arthritis
treated with Methotrexate and/or Leflunomide. Ann Rheum
Dis 2010;69(1):43-7
Bird P, Griffiths H. Multi-Centre, Cross-Sectional, Observational
Study of the Safety of Methotrexate and Leflunomide
in Combination in the Treatment of Patients
with Rheumatoid Arthritis. The SMILE Study-Safety
of Methotrexate in Combination with Leflunomide [abstract
. ACR meeting, 2010
Chopra A, Saluja M, Lagu-Joshiv V, Sarmukadam S.
Leflunomide is a useful DMARD in Indian (Asian)
patients. A clinic based observational study of 1year
treatment. Clin Rheumatol 2008; 27(8):1039-44
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Fuad Shaikh, Shaikh Nadeem Ahmed, Shamaila Khalid, Nasim Karim
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0 
