Efficacy and safety of leflunomide treatment in Takayasu arteritis: Case series from the East China cohort

Semin Arthritis Rheum. 2020 Feb;50(1):59-65. doi: 10.1016/j.semarthrit.2019.06.009. Epub 2019 Jun 13.

Abstract

Objective: To evaluate the efficacy and safety of leflunomide (LEF) as induction treatment in a series of Takayasu arteritis (TA) patients based on a Chinese cohort.

Method: Fifty-six patients from the East China TA cohort treated with LEF for at least 3 months were enrolled in this study, including the naïve LEF treatment patients (n = 41) and the cyclophosphamide (CYC)-resistant LEF treatment patients (n = 15). Data in clinical features, NIH score and angiography were collected. Response to treatment was assessed by rates of complete remission (CR) and partial remission (PR) and response rate (RR) after 6 and 12 months of treatment.

Results: The total CR rate and RR were 67.86% and 83.93% after 6 months, and 55.36% and 69.64% after 12 months, respectively. ESR and CRP levels and NIH scores decreased significantly after 12 months of LEF treatment (P < 0.05). Patients of CYC-resistant switched to LEF and reached the CR of 60.00% (9/15) and RR of 86.67% (13/15) after 6 months, and 73.33% (11/15) and 80.00% (12/15) after 12 months, respectively, with decrease in NIH scores (all P < 0.05). After following up for 14.44 ± 6.86 months, 48 patients (85.71%) continued LEF treatment with good tolerance. One patient died from progression of TA after 2 months, 2 patients relapsed, and 3 patients with side effects were switched to other immunosuppressive agents.

Conclusions: LEF led to a quick induction and sustained remission of TA, especially in refractory cases, and therefore, should be considered as an alternative treatment for TA.

Keywords: Cohort; Leflunomide; Takayasu arteritis; Treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • China
  • Cyclophosphamide / adverse effects
  • Cyclophosphamide / therapeutic use*
  • Disease Progression
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Leflunomide / adverse effects
  • Leflunomide / therapeutic use*
  • Magnetic Resonance Angiography
  • Male
  • Remission Induction
  • Takayasu Arteritis / diagnostic imaging
  • Takayasu Arteritis / drug therapy*
  • Treatment Outcome
  • Young Adult

Substances

  • Immunosuppressive Agents
  • Cyclophosphamide
  • Leflunomide