title: Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group.
abstract: BACKGROUND
  Leflunomide is a reversible inhibitor of de novo pyrimidine synthesis shown to be effective in a phase 2 trial in 402 patients with active rheumatoid arthritis (RA).
  
  
  OBJECTIVE
  To compare the efficacy and safety of leflunomide treatment with placebo and methotrexate treatment in patients with active RA.
  
  
  METHODS
  Randomized, double-blind, placebo, and active-controlled 12-month study.
  
  
  METHODS
  Forty-seven university and private rheumatology practices in the United States and Canada.
  
  
  METHODS
  Diagnosis of RA by the American College of Rheumatology (ACR) criteria for duration of 6 months or longer and no previous methotrexate treatment.
  
  
  METHODS
  Leflunomide treatment (20 mg/d), placebo, or methotrexate treatment (7.5-15 mg/wk).
  
  
  METHODS
  American College of Rheumatology success rate (completed 52 weeks of treatment and met the ACR > or = 20% response criteria), disease progression as assessed by x-ray films, and improvement in function and health-related quality of life using the intent-to-treat population.
  
  
  RESULTS
  The 482 patients studied were predominantly women (mean age, 54 years; mean disease duration, 6.7 years) for whom a mean of 0.8 disease-modifying antirheumatic drugs had failed. The ACR response and success rates for patients receiving leflunomide treatment (52% and 41%, respectively) and methotrexate treatment (46% and 35%, respectively) were significantly higher than those for patients receiving placebo (26% and 19%, respectively) (P<.001), and they were statistically equivalent, with mean time to initial response at 8.4 weeks for patients receiving leflunomide vs 9.5 weeks for patients receiving methotrexate therapy. X-ray analyses demonstrated less disease progression with leflunomide (P=.001) and methotrexate (P = .02) therapy than with placebo. Leflunomide and methotrexate treatment improved measures of physical function and health-related quality of life significantly more than placebo (P<.001 and P<.05, respectively). Common adverse events for patients receiving leflunomide treatment included gastrointestinal complaints, skin rash, and reversible alopecia. Asymptomatic transaminase elevations resulted in treatment discontinuations for 7.1% of patients receiving leflunomide therapy, 1.7% of patients receiving placebo, and 3.3% of patients receiving methotrexate therapy.
  
  
  CONCLUSIONS
  Clinical responses following administration of leflunomide, a new therapeutic agent for the treatment of RA, were statistically superior to those with placebo and equivalent to those with methotrexate treatment. Both active treatments improved signs and symptoms of active RA, delayed disease progression as demonstrated by x-ray films, and improved function and health-related quality of life.
authors.affiliation: Stanford University, Calif, USA. vstrand@aol.com
authors.forename: V
authors.initials: V
authors.lastname: Strand
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Schiff
authors.forename: A
authors.initials: A
authors.lastname: Weaver
authors.forename: R
authors.initials: R
authors.lastname: Fleischmann
authors.forename: G
authors.initials: G
authors.lastname: Cannon
authors.forename: R
authors.initials: R
authors.lastname: Fox
authors.forename: L
authors.initials: L
authors.lastname: Moreland
authors.forename: N
authors.initials: N
authors.lastname: Olsen
authors.forename: D
authors.initials: D
authors.lastname: Furst
authors.forename: J
authors.initials: J
authors.lastname: Caldwell
authors.forename: J
authors.initials: J
authors.lastname: Kaine
authors.forename: J
authors.initials: J
authors.lastname: Sharp
authors.forename: F
authors.initials: F
authors.lastname: Hurley
authors.forename: I
authors.initials: I
authors.lastname: Loew-Friedrich
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000201:enzymology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D000077339:Leflunomide; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D007555:Isoxazoles; D000637:Transaminases; D000077339:Leflunomide; D008727:Methotrexate