Leflunomide improves psoriasis in patients with psoriatic arthritis: an in-depth analysis of data from the TOPAS study.
BACKGROUND
Leflunomide has shown promise in the treatment of psoriasis.


OBJECTIVE
To provide an in-depth analysis of the effect of leflunomide on psoriasis in patients with psoriatic arthritis (PsA).


METHODS
190 patients with plaque psoriasis (at least 3% skin involvement) and active PsA were randomized to double-blind treatment with leflunomide (100 mg/day loading dose for 3 days followed by 20 mg/day orally) or placebo for 24 weeks.


RESULTS
As previously reported, leflunomide resulted in a significantly higher Psoriatic Arthritis Response Criteria response rate than placebo (58.9 vs. 29.7%; p < 0.0001). Significant differences in favor of leflunomide were also observed in the Psoriasis Area and Severity Index (PASI 50 in 30.4% of patients vs. 18.9% for placebo; p = 0.05), target lesion response (46.4 vs. 25.3%; p = 0.0048), combined skin and joint response (27.2 vs. 8.9%; p < 0.0001), Dermatology Life Quality Index (improvement of 1.9 points vs. 0.2; p = 0.0173) and certain SF-36 subdomains. Dermatological responses were observed at the earliest examination (4 weeks) and increased throughout the 24-week study.


CONCLUSIONS
Once-daily oral leflunomide is an effective and convenient treatment for PsA and plaque psoriasis.
Nash
Peter
P
Nambour General Hospital and University of Queensland, Brisbane, Australia. pnash@tpg.com.au
Thaçi
Diamant
D
Behrens
Frank
F
Falk
Franziska
F
Kaltwasser
J Peter
JP
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007555:Isoxazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D011788:Quality of Life; D012867:Skin / Q000473:pathology
D000276:Adjuvants, Immunologic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D000077339:Leflunomide