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Efficacy of leflunomide in the treatment of vasculitis


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17

 

  1. Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, ON, Canada.
  2. Division of Rheumatology, St. Joseph’s Health Care London Hospital, London, ON, Canada.
  3. Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, ON, Canada.
  4. Department of Biostatistics, University of South Florida, Tampa, FL, USA.
  5. Division of Rheumatology, McMaster University, Hamilton, ON, Canada.
  6. Division of Rheumatology, University of Utah, Salt Lake City, UT, USA.
  7. Division of Rheumatology, Cleveland Clinic, Cleveland, OH, USA.
  8. Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.
  9. Division of Rheumatology, University of Ottawa, ON, Canada.
  10. Division of Rheumatology, University of Pittsburgh, PA, USA.
  11. Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA.
  12. Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA.
  13. Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
  14. Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.
  15. Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
  16. Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA USA.
  17. Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, ON, Canada. christian.pagnoux@sinaihealthsystem.ca

on behalf of the Canadian Vasculitis Research Network (CanVasc) and Vasculitis Clinical Research Consortium (VCRC)

CER13385
2021 Vol.39, N°2 ,Suppl.129
PI 0114, PF 0118
Treatment

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PMID: 33200732 [PubMed]

Received: 31/03/2020
Accepted : 29/06/2020
In Press: 10/11/2020
Published: 19/05/2021

Abstract

OBJECTIVES:
Only a few small case series, case reports, and one small clinical trial suggested some benefit of leflunomide (LEF) in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and other vasculitides. We analysed the clinical efficacy and tolerability of LEF in a large cohort of patients with various vasculitides.
METHODS:
This was a retrospective analysis of patients who received LEF for treatment of their vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Study and in 3 additional centres from the Canadian vasculitis research network (CanVasc).
RESULTS:
Data for 93 patients were analysed: 45 had granulomatosis with polyangiitis (GPA), 8 microscopic polyangiitis (MPA), 12 eosinophilic granulomatosis with polyangiitis (EGPA), 14 giant-cell arteritis (GCA), 9 Takayasu’s arteritis (TAK), and 5 polyarteritis nodosa (PAN). The main reason for initiation of LEF was active disease (89%). LEF was efficacious for remission induction or maintenance at 6 months for 62 (67%) patients (64% with GCA, 89% with TAK, 80% with PAN, 69% with GPA, 75% with MPA, 33% with EGPA); 20% discontinued LEF before achieving remission because of persistent disease activity. Overall, 22 adverse events (gastrointestinal symptoms being the most common) led to drug discontinuation in 18 (19%) patients, of which 12 stopped LEF before month 6, before showing any benefit in 8/12 of these patients.
CONCLUSIONS:
Leflunomide can be an effective therapeutic option for various vasculitides, especially for non-severe refractory or relapsing ANCA-associated vasculitis or large-vessel vasculitis. No new safety signals for LEF were identified in this population.

Rheumatology Article

Rheumatology Addendum