title: Double blind, randomised, placebo controlled study of leflunomide in the treatment of active ankylosing spondylitis.
abstract: OBJECTIVE
  To assess the efficacy and safety of leflunomide in active ankylosing spondylitis (AS) compared with placebo in a 24 week pilot study.
  
  
  METHODS
  In a single centre randomised, double blind, placebo controlled study, 45 patients with active AS were randomised to either leflunomide 20 mg daily (n=30) or placebo (n=15). Active disease was defined as a score of >or=4 on the Bath ankylosing spondylitis disease activity index (0-10), and pain of >or=4 on a visual analogue scale (0-10). The primary efficacy variable at week 24 was the 20% response rate, as recommended by the Assessments in Ankylosing Spondylitis (ASAS) working group. Secondary outcome variables included general wellbeing, metrology index, swollen joint count, erythrocyte sedimentation rate, and C reactive protein.
  
  
  RESULTS
  In all, 13 women and 32 men were studied. Demographic and disease indices were comparable between the two treatment groups at baseline. The rate of ASAS 20% responders was not significantly different: 27% in the leflunomide treated patients and 20% in the placebo group (95% confidence interval, -32% to 19%). No significant differences were found between the treatment groups in mean changes of the secondary outcome variables. Eleven patients were withdrawn prematurely from the study because of adverse events (7), lack of efficacy (3), and non-compliance (1). Most frequently adverse events were gastrointestinal side effects and skin disorders.
  
  
  CONCLUSIONS
  In this placebo controlled study, leflunomide treatment did not result in a significant improvement of the ASAS 20% response in active ankylosing spondylitis. No unexpected or severe adverse events occurred.
authors.affiliation: VU University Medical Centre, Department of Rheumatology 4A-42, PO Box 7057, 1007 MB Amsterdam, Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: van Denderen
authors.forename: M
authors.initials: M
authors.lastname: van der Paardt
authors.forename: M T
authors.initials: MT
authors.lastname: Nurmohamed
authors.forename: Y M M A
authors.initials: YM
authors.lastname: de Ryck
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: I E
authors.initials: IE
authors.lastname: van der Horst-Bruinsma
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects / Q000627:therapeutic use*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010349:Patient Compliance; D010352:Patient Dropouts; D010865:Pilot Projects; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide