THE PLACE OF LEFLUNOMIDE IN DISEASE-MODIFYING THERAPY OF RHEUMATOID ARTHRITIS: NEW ASPECTS

Abstract

A new mechanism of lefl unomide (LEF) action was recently discovered, namely its ability to infl uence the intracellular mechanism of the infl ammatory process by inhibiting JAK kinases, which brings it closer to the new most eff ective group for treatment of rheumatoid arthritis (RA) – Janus kinase inhibitors. The article presents data from both our own and other authors’ studies on the eff ectiveness and safety of the drug in comparison with other synthetic and biological basic agents. The aim of our study was a comparative evaluation of LEF, methotrex- ate (MTX), sulfasalazine (SS) and their combinations (CDT) in 402 patients with RA. Obtained results showed advantages of LEF and СDT over the use of SS (at any RA duration) and MTX (at late RA). Adverse events were the lowest in the SS group, and disease-modifying anti-rheumatic drug (DMARD) discontinuation due to complications was the lowest in the LEF group. Based on the results of multifactor regression analysis, we developed a scheme of individualized selection of the most eff ective DMARD depending on the initial characteristics of RA patients. The article also presents international study data. It analyses the comparative effi cacy of LEF (10-20 mg/d) and low doses of rituximab (500 mg twice daily) in patients refractory to MTX therapy; effi cacy of LEF in monotherapy (5-40 mg/d) and combination with other DMARD; LEF at a dose of 100 mg/week and MTX at a dose of 10 mg/week; LEF at a dose of 50 mg once a week and 10 mg daily. The eff ect of LEF on uric acid levels and bone mineral density of the lumbar spine in patients with RA was studied.