Combo MTX and Leflunomide in Psoriatic Arthritis Save
A recent study has shown that the combination of methotrexate (MTX) plus leflunomide (LEF) yields better disease control in psoriatic arthritis, but may not be as well tolerated as monotherapy with MTX.
This single center from the Netherlands randomised adults with psoriatic arthritis (psoriatic arthritis disease activity score [PASDAS] ≥5·4) to either 15-25 mg/wk of MTX plus 20 mg qd of LEF (combination therapy) or MTX plus placebo (monotherapy). The primary outcome was the change in PASDAS at week 16.
A total of 78 PsA patients were randomized and treated. Week 16 outcomes were:
- Combination Therapy - PASDAS 3·1 [SD 1·4]
- Monotherapy - PASDAS 3·7 [SD 1·3] (p=0·025).
While there were no deaths and no differences in major adverse events (AE), the combination group had more nausea or vomiting (44% vs. 28%), tiredness (23% vs 33%) and elevated alanine aminotransferase levels (31% vs 18%).
LEF use is not often advocated in the treatment of PsA, but this blinded, randomized pilot trial shows that adding LEF to MTX yields significantly better results in active PsA (according to PASDAS improvement).
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Halliwell group has done an interesting as well as practical study, amid the plethora of target therapy of psoriatic disease.
While Leflunomide was known to be more transaminase provoking and with our experience with 10 mg leflunomide, I wonder whether one might avoid the same day combination dosing; since Mtx needs only one day a week, by using lower dose Leflunomide and avoid same day Mtx-Lef administration might not be a viable combination strategy to avoid some of the reported adverse effect.
Disclosures
The author has no conflicts of interest to disclose related to this subject
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