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Update 2011: leflunomide in rheumatoid arthritis - strengths and weaknesses.

机译:2011年更新:类风湿关节炎中来氟米特的优缺点。

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PURPOSE OF REVIEW: Leflunomide is often used as a first choice disease-modifying antirheumatic drug after methotrexate. New data are available for efficacy and safety in both, monotherapy and combination with biologicals. RECENT FINDINGS: New data on efficacy demonstrate comparable effect sizes for leflunomide and methotrexate in the treatment of signs and symptoms in combination with tumour necrosis factor-blocking agents and rituximab. Equipotency has also been demonstrated by a recent radiographic outcome study on methotrexate and leflunomide monotherapy. Pharmacogenetic studies indicate an impact of polymorphisms on the variability in serum levels of the compound with potential relevance to effectiveness and tolerability in individual patients. Genetic factors are also likely to contribute to the significantly increased risk for leflunomide-induced pulmonary disease reported in Asia. Because pre-existing interstitial lung disease as well as methotrexate-induced pneumonitis have been identified as risk factors for leflunomide-induced pulmonary disease, the use of leflunomide as an alternative to methotrexate is limited under these conditions. SUMMARY: Effectiveness of leflunomide renders it a potent treatment option in rheumatoid arthritis. The known tolerability issues resulting in a less favourable adherence to therapy constitutes a weakness. However, documented data from large registries indicate that leflunomide is safe as far as the contraindications and recommendations for monitoring are regarded.
机译:审查的目的:来氟米特经常被用作甲氨蝶呤后的首选抗病,抗风湿药。在单一疗法或与生物制剂联合使用中,有关有效性和安全性的新数据可用。最新发现:有关功效的新数据表明,来氟米特和氨甲蝶呤与肿瘤坏死因子阻断剂和利妥昔单抗联合使用在治疗症状和体征方面具有可比的效果。最近关于甲氨蝶呤和来氟米特单药治疗的影像学结果研究也证明了等效性。药物遗传学研究表明,多态性对化合物血清水平的变异性有影响,与个体患者的有效性和耐受性有关。遗传因素也可能导致亚洲报告的来氟米特引起的肺部疾病的风险大大增加。由于已经确定间质性肺疾病以及甲氨蝶呤引起的肺炎是来氟米特引起的肺部疾病的危险因素,因此在这些情况下,来氟米特替代甲氨蝶呤的使用受到限制。摘要:来氟米特的有效性使其成为类风湿关节炎的有效治疗选择。导致对治疗的依从性较差的已知耐受性问题构成了一个弱点。但是,来自大型注册机构的书面数据表明,就考虑到禁忌症和监测建议而言,来氟米特是安全的。

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