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Similar response seen for methotrexate and other DMARDs when combined with anti-TNFs for RA

Combination of tumour necrosis factor inhibitors (anti-TNFs) withleflunomide or other disease-modifying antirheumatic drugs (DMARDs)might be as safe and effective for patients with rheumatoid arthritisas co-administration with methotrexate, a Swiss study suggests

Combination of tumour necrosis factor inhibitors (anti-TNFs) with leflunomide or other disease-modifying antirheumatic drugs (DMARDs) might be as safe and effective for patients with rheumatoid arthritis as co-administration with methotrexate, a Swiss study suggests (Annals of the Rheumatic Diseases 2009;68:33).

Richard Copeland, lead pharmacist for clinical governance at Northumbria Healthcare NHS Trust and specialist pharmacist in rheumatology, commented on the study.

“While anti-TNF treatments are licensed for single administration or co-prescription with methotrexate, they are sometimes prescribed with other DMARDs,” he explained.

“This is an interesting study, although its title suggests perhaps that only leflunomide is being studied; from 1,218 datasets, taken from a registry of 2,097 patients, there were no differences in effectiveness and safety found between methotrexate, leflunomide or other DMARDs when combined with anti-TNF treatment.”

Most of the patients in the study used methotrexate as co-therapy (69%). Leflunomide was used with anti-TNF therapy for 21% of patients and other DMARDs for 10%.

The researchers observed no significant difference between groups in measures of radiographic damage progression, functional disability progression or evolution of rheumatoid arthritis.

Mr Copeland said: “This provides some confidence that co-prescription of leflunomide with anti-TNF treatment might be a reasonable option for patients unable to take methotrexate. There are currently around 15,500 patients recorded on the British Society of Rheumatology biologicals register as having received anti-TNFs in the UK.

“It would be interesting to see whether the incidence of leflunomide co-prescribing is similar in the UK to that in Switzerland.”

Citation: Clinical Pharmacist URI: 10048198

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Supplementary images

  • Coloured X-ray of a rheumatoid arthritis-affected hand (Du Cane Medical Imaging Ltd | SPL)

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