II. Indications: Rheumatoid Arthritis

  1. First line DMARD instead or Methotrexate
  2. Combination with Methotrexate

III. Mechanism

  1. Pyrimidine inhibitor
  2. T-Cell Activation and proliferation inhibitor
  3. Similar to Methotrexate in effects
  4. Onset of action in 1-2 months

IV. Efficacy

  1. Comparable to Methotrexate
  2. Used with Methotrexate for maximal effect

V. Adverse effects

  1. Nausea (may limit use)
  2. Alopecia
  3. Liver injury occurs in 1 in 200 patients
    1. Increased Liver transaminases (e.g. AST, SGOT)
  4. Lung injury (observe for new onset cough)

VI. Monitoring

  1. Labs:
    1. Aspartate Transaminase (SGOT, AST)
    2. Complete Blood Count with Platelet Count
  2. History
    1. Ask about new onset cough
  3. Timing
    1. Check monthly for 6 months
    2. Check every 6-8 weeks

VII. Dose

  1. Loading dose: 100 mg PO qd for 3 days
  2. Maintenance: 10 mg PO qd (or 20 mg PO qod)
  3. Inadequate relief at lower dose: 20 mg PO qd

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Cost: Medications

leflunomide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LEFLUNOMIDE 10 MG TABLET Generic $0.44 each
LEFLUNOMIDE 20 MG TABLET Generic $0.50 each