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Published in: Rheumatology International 2/2013

01-02-2013 | Review Article

Leflunomide: friend or foe for systemic lupus erythematosus?

Authors: Guo-Cui Wu, Xiao-Di Xu, Qiong Huang, Hua Wu

Published in: Rheumatology International | Issue 2/2013

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Abstract

Leflunomide is a new immunosuppressive medicine that has been effectively used in the therapy of rheumatoid arthritis and subsequently used with success in animal models and patients with systemic lupus erythematosus (SLE). However, its use has also been associated with significant and serious adverse reactions involving hematological, hepatic, immune, dermatological and respiratory systems. In the current review, we attempt to describe the two sides of this drug in the treatment of SLE.
Literature
1.
go back to reference Smolen JS, Graninger WB, Emery P (2000) Leflunomide, a new disease-modifying anti-rheumatic drug and the never ending rheumatoid arthritis story. Rheumatology (Oxford) 39:689–692CrossRef Smolen JS, Graninger WB, Emery P (2000) Leflunomide, a new disease-modifying anti-rheumatic drug and the never ending rheumatoid arthritis story. Rheumatology (Oxford) 39:689–692CrossRef
2.
go back to reference Strand V, Cohen S, Schiff M et al (1999) Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group. Arch Intern Med 159:2542–2550PubMedCrossRef Strand V, Cohen S, Schiff M et al (1999) Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group. Arch Intern Med 159:2542–2550PubMedCrossRef
3.
go back to reference Smolen JS, Kalden JR, Scott DL et al (1999) Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group. Lancet 353:259–266PubMedCrossRef Smolen JS, Kalden JR, Scott DL et al (1999) Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group. Lancet 353:259–266PubMedCrossRef
4.
go back to reference Emery P, Breedveld FC, Lemmel EM et al (2000) A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology 39:655–665PubMedCrossRef Emery P, Breedveld FC, Lemmel EM et al (2000) A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology 39:655–665PubMedCrossRef
5.
go back to reference Breedveld FC, Dayer JM (2000) Leflunomide: mode of action in the treatment of rheumatoid arthritis. Ann Rheum Dis 59:841–849PubMedCrossRef Breedveld FC, Dayer JM (2000) Leflunomide: mode of action in the treatment of rheumatoid arthritis. Ann Rheum Dis 59:841–849PubMedCrossRef
6.
go back to reference Popovic S, Bartlett RR (1987) The use of the murine chronic graft vs host (CGVH) disease, a model for systemic lupus erythematosus (SLE), for drug discovery. Agents Actions 21:284–286PubMedCrossRef Popovic S, Bartlett RR (1987) The use of the murine chronic graft vs host (CGVH) disease, a model for systemic lupus erythematosus (SLE), for drug discovery. Agents Actions 21:284–286PubMedCrossRef
7.
go back to reference Bartlett RR, Popovic S, Raiss RX (1988) Development of autoimmunity in MRL/lpr mice and the effects of drugs on this murine disease. Scand J Rheumatol Suppl 75:290–299PubMedCrossRef Bartlett RR, Popovic S, Raiss RX (1988) Development of autoimmunity in MRL/lpr mice and the effects of drugs on this murine disease. Scand J Rheumatol Suppl 75:290–299PubMedCrossRef
8.
go back to reference Petera P, Manger B, Rosenburg R et al (2000) A pilot study of leflunomide in systemic lupus erythematosus (SLE). Arthritis Rheum 43:S241 Petera P, Manger B, Rosenburg R et al (2000) A pilot study of leflunomide in systemic lupus erythematosus (SLE). Arthritis Rheum 43:S241
9.
go back to reference Remer CF, Weisman MH, Wallace DJ (2001) Benefits of leflunomide in systemic lupus erythematosus: a pilot observational study. Lupus 10:480–483PubMedCrossRef Remer CF, Weisman MH, Wallace DJ (2001) Benefits of leflunomide in systemic lupus erythematosus: a pilot observational study. Lupus 10:480–483PubMedCrossRef
10.
go back to reference Petri M (2001) High dose arava in lupus (HAIL). Arthritis Rheum 44:S280 Petri M (2001) High dose arava in lupus (HAIL). Arthritis Rheum 44:S280
11.
go back to reference Kessel A, Toubi E (2002) Leflunomide in systemic lupus erythematosus. Harefuah 141:355–357PubMed Kessel A, Toubi E (2002) Leflunomide in systemic lupus erythematosus. Harefuah 141:355–357PubMed
12.
go back to reference Tam LS, Li EK, Wong CK et al (2004) Double-blind, randomized, placebo-controlled pilot study of leflunomide in systemic lupus erythematosus. Lupus 13:601–604PubMedCrossRef Tam LS, Li EK, Wong CK et al (2004) Double-blind, randomized, placebo-controlled pilot study of leflunomide in systemic lupus erythematosus. Lupus 13:601–604PubMedCrossRef
13.
go back to reference Cui TG, Hou FF, Ni ZH et al (2005) Treatment of proliferative lupus nephritis with leflunomide and steroid: a prospective multi-center controlled clinical trial. Zhonghua Nei Ke Za Zhi 44:672–676 [In Chinese]PubMed Cui TG, Hou FF, Ni ZH et al (2005) Treatment of proliferative lupus nephritis with leflunomide and steroid: a prospective multi-center controlled clinical trial. Zhonghua Nei Ke Za Zhi 44:672–676 [In Chinese]PubMed
14.
go back to reference Tam LS, Li EK, Wong CK et al (2006) Safety and efficacy of leflunomide in the treatment of lupus nephritis refractory or intolerant to traditional immunosuppressive therapy: an open label trial. Ann Rheum Dis 65:417–418PubMedCrossRef Tam LS, Li EK, Wong CK et al (2006) Safety and efficacy of leflunomide in the treatment of lupus nephritis refractory or intolerant to traditional immunosuppressive therapy: an open label trial. Ann Rheum Dis 65:417–418PubMedCrossRef
15.
go back to reference Wang HY, Cui TG, Hou FF et al (2008) Induction treatment of proliferative lupus nephritis with leflunomide combined with prednisone: a prospective multi-centre observational study. Lupus 17:638–644PubMedCrossRef Wang HY, Cui TG, Hou FF et al (2008) Induction treatment of proliferative lupus nephritis with leflunomide combined with prednisone: a prospective multi-centre observational study. Lupus 17:638–644PubMedCrossRef
16.
go back to reference Holm EA, Balslev E, Jemec GB (2001) Vasculitis occurring during leflunomide therapy. Dermatology 203:258–259PubMedCrossRef Holm EA, Balslev E, Jemec GB (2001) Vasculitis occurring during leflunomide therapy. Dermatology 203:258–259PubMedCrossRef
17.
go back to reference Carulli MT, Davies UM (2002) Peripheral neuropathy: an unwanted effect of leflunomide? Rheumatology 41:952–953PubMedCrossRef Carulli MT, Davies UM (2002) Peripheral neuropathy: an unwanted effect of leflunomide? Rheumatology 41:952–953PubMedCrossRef
18.
go back to reference Soliotis F, Glover M, Jawad AS (2002) Severe skin reaction after leflunomide and etanercept in a patient with rheumatoid arthritis. Ann Rheum Dis 61:850–851PubMedCrossRef Soliotis F, Glover M, Jawad AS (2002) Severe skin reaction after leflunomide and etanercept in a patient with rheumatoid arthritis. Ann Rheum Dis 61:850–851PubMedCrossRef
19.
go back to reference Chan AT, Bradlow A, McNally J (2003) Leflunomide induced vasculitisea dose-response relationship. Rheumatology 42:492–493PubMedCrossRef Chan AT, Bradlow A, McNally J (2003) Leflunomide induced vasculitisea dose-response relationship. Rheumatology 42:492–493PubMedCrossRef
20.
go back to reference Fischer TW, Bauer HI, Graefe T et al (2003) Erythema multiforme-like drug eruption with oral involvement after intake of leflunomide. Dermatology 207:386–389PubMedCrossRef Fischer TW, Bauer HI, Graefe T et al (2003) Erythema multiforme-like drug eruption with oral involvement after intake of leflunomide. Dermatology 207:386–389PubMedCrossRef
21.
go back to reference van Roon EN, Jansen TL et al (2004) Leflunomide for the treatment of rheumatoid arthritis in clinical practice: incidence and severity of hepatotoxicity. Drug Saf 27:345–352PubMedCrossRef van Roon EN, Jansen TL et al (2004) Leflunomide for the treatment of rheumatoid arthritis in clinical practice: incidence and severity of hepatotoxicity. Drug Saf 27:345–352PubMedCrossRef
22.
go back to reference Chan J, Sanders DC, Du L et al (2004) Leflunomide associated pancytopenia with or without methotrexate. Ann Pharmacother 38:1206–1211PubMedCrossRef Chan J, Sanders DC, Du L et al (2004) Leflunomide associated pancytopenia with or without methotrexate. Ann Pharmacother 38:1206–1211PubMedCrossRef
23.
24.
go back to reference Bonnel RA, Graham DJ (2004) Peripheral neuropathy in patients treated with leflunomide. Clin Pharmacol Ther 75:580–585PubMedCrossRef Bonnel RA, Graham DJ (2004) Peripheral neuropathy in patients treated with leflunomide. Clin Pharmacol Ther 75:580–585PubMedCrossRef
25.
go back to reference Kamata Y, Nara H, Kamimura T et al (2004) Rheumatoid arthritis complicated with acute intersitial pneumonia induced by leflunomide as an adverse reaction. Intern Med 43:1201–1204PubMedCrossRef Kamata Y, Nara H, Kamimura T et al (2004) Rheumatoid arthritis complicated with acute intersitial pneumonia induced by leflunomide as an adverse reaction. Intern Med 43:1201–1204PubMedCrossRef
26.
go back to reference Kerr OA, Murray CS, Tidman MJ (2004) Subacute cutaneous lupus erythematosus associated with leflunomide. Clin Exp Dermatol 29:319–320PubMedCrossRef Kerr OA, Murray CS, Tidman MJ (2004) Subacute cutaneous lupus erythematosus associated with leflunomide. Clin Exp Dermatol 29:319–320PubMedCrossRef
27.
go back to reference Goeb V, Berhelot JM, Joly P et al (2005) Leflunomide-induced subacute cutaneous lupus erythematosus. Rheumatology 44:823–824PubMedCrossRef Goeb V, Berhelot JM, Joly P et al (2005) Leflunomide-induced subacute cutaneous lupus erythematosus. Rheumatology 44:823–824PubMedCrossRef
28.
go back to reference Gensburger D, Kawashima M, Marotte H et al (2005) Lupus erythematosus with leflunomide: induction or reactivation? Ann Rheum Dis 64:153–155PubMedCrossRef Gensburger D, Kawashima M, Marotte H et al (2005) Lupus erythematosus with leflunomide: induction or reactivation? Ann Rheum Dis 64:153–155PubMedCrossRef
29.
go back to reference Takeishi M, Akiyama Y, Akiba H et al (2005) Leflunomide induced acute interstitial pneumonia. J Rheumatol 32:1160–1163PubMed Takeishi M, Akiyama Y, Akiba H et al (2005) Leflunomide induced acute interstitial pneumonia. J Rheumatol 32:1160–1163PubMed
30.
go back to reference Fox RI, Herrmann ML, Frangou CG et al (1999) Mechanism of action for leflunomide in rheumatoid arthritis. Clin Immunol 93:198–208PubMedCrossRef Fox RI, Herrmann ML, Frangou CG et al (1999) Mechanism of action for leflunomide in rheumatoid arthritis. Clin Immunol 93:198–208PubMedCrossRef
31.
go back to reference González-Alvaro I, Ortiz AM, Domínguez-Jiménez C et al (2009) Inhibition of tumour necrosis factor and IL-17 production by leflunomide involves the JAK/STAT pathway. Ann Rheum Dis 68:1644–1650PubMedCrossRef González-Alvaro I, Ortiz AM, Domínguez-Jiménez C et al (2009) Inhibition of tumour necrosis factor and IL-17 production by leflunomide involves the JAK/STAT pathway. Ann Rheum Dis 68:1644–1650PubMedCrossRef
32.
go back to reference Manna SK, Mukhopadhyay A, Aggarwal BB (2000) Leflunomide suppresses TNF-induced cellular responses: effects on NF-kappa B, activator protein-1, c-Jun N-terminal protein kinase, and apoptosis. J Immunol 165:5962–5969PubMed Manna SK, Mukhopadhyay A, Aggarwal BB (2000) Leflunomide suppresses TNF-induced cellular responses: effects on NF-kappa B, activator protein-1, c-Jun N-terminal protein kinase, and apoptosis. J Immunol 165:5962–5969PubMed
33.
go back to reference Manna SK, Aggarwal BB (1999) Immunosuppressive leflunomide metabolite (A77 1726) blocks TNF-dependent nuclear factor-kappa B activation and gene expression. J Immunol 162:2095–2102PubMed Manna SK, Aggarwal BB (1999) Immunosuppressive leflunomide metabolite (A77 1726) blocks TNF-dependent nuclear factor-kappa B activation and gene expression. J Immunol 162:2095–2102PubMed
34.
go back to reference He C, Lu X, Yan Z et al (2012) Therapeutic effect of leflunomide on the development of experimental lupus nephritis in mice. Rheumatol Int 32:633–638PubMedCrossRef He C, Lu X, Yan Z et al (2012) Therapeutic effect of leflunomide on the development of experimental lupus nephritis in mice. Rheumatol Int 32:633–638PubMedCrossRef
35.
go back to reference Bes C, Soy M (2011) Pseudo-pseudo Meigs syndrome developed under the leflunomide therapy. Rheumatol Int 31:521–523PubMedCrossRef Bes C, Soy M (2011) Pseudo-pseudo Meigs syndrome developed under the leflunomide therapy. Rheumatol Int 31:521–523PubMedCrossRef
36.
go back to reference Suess A, Sticherling M (2008) Leflunomide in subacute cutaneous lupus erythematosus-two sides of a coin. Int J Dermatol 47:83–86PubMedCrossRef Suess A, Sticherling M (2008) Leflunomide in subacute cutaneous lupus erythematosus-two sides of a coin. Int J Dermatol 47:83–86PubMedCrossRef
37.
go back to reference Chan SK, Hazleman BL, Burrows NP (2004) Subacute cutaneous lupus erythematosus precipitated by leflunomide. Clin Exp Dermatol 29:724–725 Chan SK, Hazleman BL, Burrows NP (2004) Subacute cutaneous lupus erythematosus precipitated by leflunomide. Clin Exp Dermatol 29:724–725
Metadata
Title
Leflunomide: friend or foe for systemic lupus erythematosus?
Authors
Guo-Cui Wu
Xiao-Di Xu
Qiong Huang
Hua Wu
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Rheumatology International / Issue 2/2013
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-012-2508-z

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