title: Leflunomide-induced interstitial lung disease (a systematic review).
abstract: BACKGROUND
  Leflunomide, a disease modifying anti-rheumatic drug in use since 1998, causes interstitial lung disease (ILD) and other pulmonary complications.
  
  
  METHODS
  We undertook a systematic review of literature of PubMed (March 2013) to identify the published literature pertaining to pulmonary toxicity associated with leflunomide.
  
  
  RESULTS
  We identified 41 relevant articles detailing four population studies and case reports/series on an additional 42 patients. Available data were reviewed and summarized.
  
  
  CONCLUSIONS
  Leflunomide can cause ILD. Most of these patients present within three months of starting leflunomide with acute symptoms for a week or less. Bilateral ground glass opacities and diffuse alveolar damage are the most common radiologic and histopathologic findings, respectively. Patients with pre-existing ILD are particularly at risk for this complication, and leflunomide should be avoided in this population. Activated charcoal and cholestyramine significantly decrease the half-life of the drug because of its enterohepatic circulation and should be considered in cases with acute toxicity.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL. rishi.raj@northwestern.edu.
authors.forename: R
authors.initials: R
authors.lastname: Raj
authors.forename: K
authors.initials: K
authors.lastname: Nugent
mesh_terms: D018501:Antirheumatic Agents; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents