Comparison of Leflunomide Monotherapy with Combination of Methotrexate and Hydroxychloroquine in Active Rheumatoid Arthritis

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.