Leflunomide is a new DMARD. It was approved by the FDA as a treatment for rheumatoid arthritis in October 1998, and is sold under the name Arava in the United States. This drug has a different chemical structure than other DMARDs and a unique mechanism of action for improving RA symptoms.
Leflunomide is an effective treatment for RA symptoms. In fact, medical studies demonstrate that it is as effective as methotrexate and sulfasalazine in treating the signs and symptoms of RA. Improvement of symptoms usually begins four to eight weeks after a person starts taking leflunomide. Like the other DMARDs, leflunomide also slows the joint destruction caused by RA.
Most patients with RA can tolerate treatment with leflunomide. In fact, in studies comparing the tolerability of various DMARDs, leflunomide has been shown to have fewer withdrawals from medical trials than methotrexate and sulfasalazine.
Because of its effectiveness, tolerability, and unique mechanism of action, leflunomide represents a viable alternative for patients who have failed or are intolerant to methotrexate. Interestingly, leflunomide can be given to patients who are already taking methotrexate but do not have an adequate response to the latter medication. If the patient has no preexisting liver disease and if liver function tests are monitored on a monthly basis, then leflunomide and methotrexate can be combined safely.
Because of its effectiveness, tolerability, and unique mechanism of action, leflunomide represents a viable alternative for patients who have failed or are intolerant to methotrexate.
Leflunomide has been associated with liver function abnormalities that improve after patients stop the medication. It can also cause stomach upset, diarrhea, and hair loss. Leflunomide can affect the development of fetuses, so women of childbearing age should be made aware of this risk and advised to use birth control while on this medication. Unlike other DMARDs, however, leflunomide treatment does not appear to be associated with an increased risk for infection.
Your doctor should perform regular blood tests while you're on leflunomide. These tests should include a complete blood count and liver function tests every two weeks for the first month while you are taking leflunomide, and then the same tests on a monthly basis thereafter.