title: Long term evaluation of radiographic disease progression in a subset of patients with rheumatoid arthritis treated with leflunomide beyond 2 years.
abstract: OBJECTIVE
  To assess the effect of long term (>2 years) leflunomide treatment on radiographic progression in patients with RA.
  
  
  METHODS
  Patients treated with leflunomide for >2 years in one of three phase III trials and subsequent extensions, for whom paired, evaluable radiographs at baseline and study end point were available, were included. Radiographs of hands and feet were assessed according to the modified Sharp/van der Heijde scoring method, for erosion, joint space narrowing, and total score. Changes from baseline were assessed, and a predicted yearly progression rate estimated for each patient.
  
  
  RESULTS
  128 of the original 824 patients were included, with mean disease duration 5.1 years and mean leflunomide treatment duration 4.3 years until the final x ray examination. The mean change from baseline in total score was 8.6 with yearly adjusted rate 1.9, and the median change was 2 with yearly adjusted rate 0.5, compared with 7.9 and 4.9, respectively, before leflunomide treatment. After treatment, the rate improved in 92/128 (72%) patients and deteriorated in 21/128 (16%). In 42 (33%) patients who had a total score >0 at baseline, no radiographic progression occurred after leflunomide treatment.
  
  
  CONCLUSIONS
  In a subset of patients who continued treatment long term, leflunomide treatment reduced the rate of radiographic damage.
authors.affiliation: Division of Internal Medicine, Department of Rheumatology, University Hospital Maastricht, 6202 AZ Maastricht, The Netherlands. dhe@sint.azm.nl
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.forename: J
authors.initials: J
authors.lastname: Kalden
authors.forename: D
authors.initials: D
authors.lastname: Scott
authors.forename: J
authors.initials: J
authors.lastname: Smolen
authors.forename: V
authors.initials: V
authors.lastname: Strand
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018450:Disease Progression; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007555:Isoxazoles / Q000627:therapeutic use*; D000077339:Leflunomide; D008134:Long-Term Care; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D000077339:Leflunomide