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1. Comparison of Leflunomide Monotherapy with Combination of Methotrexate and Hydroxychloroquine in Active Rheumatoid Arthritis
Muhammad Muddasser Khan Panezai, Zia Ul Haq, Shahzad Gul, Obaid Ur Rehman, Somaya Shah and Saira Tahir
ABSTRACT
Objective: We compared the clinical outcomes of Leflunomide (LEF) monotherapy with combination therapy of methotrexate (MTX) plus hydroxychloroquine for managing moderate to severe rheumatoid arthritis (RA).
Study Design: Comparative study
Place and Duration of Study: This study was conducted at the rheumatology clinic of Pakistan Institute of Medical Sciences (PIMS) Islamabad from June-2020 to July-2021.
Methods: Patients were divided in two groups as per the given treatment, either in group L or group MH. In group L, 20 mg LEF per day was given for 3 months. In group MH, 200 mg hydroxychloroquine was given for 3 months, along with hydroxychloroquine, in these patients 7.5 mg/week MTX was given for first week after that the dose was increased 2.5mg/week until it reached 25 mg/week. Patients’ follow-up was done for 3 months, data of biochemical markers and clinical outcomes was noted at each follow-up.
Results: The mean age was 42.94±10.7 years in group L and 43.15±10.2 years in group MH. Majority of studied patients were females; 27 (67.5%) in group L and 29 (72.5%) in group MH (p-value 0.62). DAS-28 after 3 months of treatment was 4.36±1.5 in group L and 4.24±1.3 in group MH (p-value 0.70). The ESR and SJC scores after 3 months of treatment was 27.3±14.5 in group L versus 26.1±11.4 and 5.1±4.9 in group L versus 5.05±4.2 in group MH. The SJC score, DAS-28 score and ESR levels reduced at each follow- up post- treatment with statistically significant difference with P < 0.001.
Conclusion: Leflunomide (LEF) monotherapy has similar efficacy in comparison to combination of methotrexate and hydroxychloroquine for managing moderate to severe RA.
Key Words: Rheumatoid arthritis, Leflunomide, methotrexate, Hydroxychloroquine