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

Cui, Xiaomeng; Dai, X.; Ma, Lili; Yang, Chengde; Tan, Wenfeng; Zhang, Liyun; Zhang, Zhenchun; Feng, Xiaoqin; Wu, Rui; Zou, Ying; Zhou, Zhenyuan; Lu, Yu; Wang, Youlian; Wu, Min; Su-pin, LI; Lin, He; Dong, Zhihui; Fu, Weiguo; Sun, Xiaoning; Wang, Chunsheng; Ding, Jing; Lv, Ping; Lin, Jia Wei; Jiang, Lindi

doi:10.1016/j.semarthrit.2019.06.009

Cited by 18 publications

(16 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…33 In one former study, we showed that LEF could improve the inflammatory status and reduce the GC dose after 6 months of treatment, and that this improvement could be sustained until 12 months. 24 In the present research, the efficacy of LEF treatment was also satisfactory. The prevalence of CR after using LEF was 72.50% and 75.58% at 6 months and 9 months, respectively, which could be sustained in 78.38% of cases at 12 months.…”

Section: Discussionsupporting

confidence: 66%

“…23 Our previous studies have also indicated that LEF can lead to quick induction (clinical response in 83.9% of cases at 6 months) and sustained remission (clinical response in 69.6% of patients) from TAK until 12 months. 24 Thus, the underlying effectiveness and good tolerability of LEF against TAK show promise.…”

Section: Effectiveness and Safety Of Methotrexate Versus Leflunomide mentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness and safety of methotrexate versus leflunomide in 12-month treatment for Takayasu arteritis

Sun

Cui

et al. 2020

Therapeutic Advances in Chronic Disease

Self Cite

View full text Add to dashboard Cite

Aims: The study investigates the effectiveness and safety of methotrexate (MTX) versus leflunomide (LEF) in 12-month treatment of Takayasu arteritis (TAK). Methods: This was a cohort study. Patients diagnosed with TAK between 1 January 2013 and 1 January 2019 were enrolled from First Hospital of China Medical University and Zhongshan Hospital of Fudan University. Patients had active disease and were treated with glucocorticoid combined with LEF or MTX. Treatment response, imaging assessment and side-effects were evaluated during 12-month follow-up. Results: In total, 68 patients were enrolled (40 cases treated with LEF and 28 treated with MTX). At baseline, age, sex, disease duration and disease activity index showed no significant differences between groups. Prevalence of complete remission (CR) at 6 months was significantly higher in the LEF group than that in the MTX group (LEF versus MTX: 72.50% versus 53.57%, p = 0.04), though the CR prevalence at 9 months and 12 months showed no significant differences between groups. At 9 months, the prevalence of treatment resistance was much lower in the LEF group compared with MTX group (5.41% versus 11.54%, p = 0.03). Furthermore, prevalence of disease relapse in the LEF group was lower than that in MTX group at 12 months (7.24% versus 16.67%, p = 0.03). Patients with high baseline C-reactive protein levels (⩾15 mg/L) carried a higher risk of treatment resistance (OR = 1.36, 95% CI 1.07–13.41, p = 0.06) and disease relapse (HR = 2.51, 95% CI 1.36–12.98, p = 0.04). Conclusion: LEF might provide a quicker treatment response with lower prevalence of disease relapse compared with that elicited in MTX during 12 months follow-up for TAK.

show abstract

Section: Discussionsupporting

confidence: 66%

Section: Effectiveness and Safety Of Methotrexate Versus Leflunomide mentioning

confidence: 99%

Effectiveness and safety of methotrexate versus leflunomide in 12-month treatment for Takayasu arteritis

Sun

Cui

et al. 2020

Therapeutic Advances in Chronic Disease

Self Cite

View full text Add to dashboard Cite

show abstract

“…Leflunomide Six observational studies (and a seventh study, a longer-term follow-up of one of the previous ones) assessed leflunomide in TAK [42,57,82,83,93,94,99]. For the three uncontrolled observational studies, the pooled proportion of patients achieving at least a partial clinical response was 80% (95% CI 70-89%, 3 studies, 73 patients, I 2 not assessable, Fig.…”

Section: Conventional Dmardsmentioning

confidence: 99%

“…One study assessed relapses (4%, 95% CI 0-12%, 56 patients, Fig. 4c) [82]. The pooled proportion of patients with adverse events was 8% (95% CI 1-19%, 3 studies, 80 patients, I 2 not assessable, Supplementary Fig.…”

Section: Conventional Dmardsmentioning

confidence: 99%

Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

The pharmacotherapy of Takayasu arteritis (TAK) with disease-modifying anti-rheumatic drugs (DMARDs) is an evolving area. A systematic review of Scopus, Web of Science, Pubmed Central, clinical trial databases and recent international rheumatology conferences for interventional and observational studies reporting the effectiveness of DMARDs in TAK identified four randomized controlled trials (RCTs, with another longer-term follow-up of one RCT) and 63 observational studies. The identified trials had some concern or high risk of bias. Most observational studies were downgraded on the Newcastle-Ottawa scale due to lack of appropriate comparator groups. Studies used heterogenous outcomes of clinical responses, angiographic stabilization, normalization of inflammatory markers, reduction in vascular uptake on positron emission tomography, reduction in prednisolone doses and relapses. Tocilizumab showed benefit in a RCT compared to placebo in a secondary per-protocol analysis but not the primary intention-to-treat analysis. Abatacept failed to demonstrate benefit compared to placebo for preventing relapses in another RCT. Pooled data from uncontrolled observational studies demonstrated beneficial clinical responses and angiographic stabilization in nearly 80% patients treated with tumour necrosis factor alpha inhibitors, tocilizumab or leflunomide. Certainty of evidence for outcomes from RCTs ranged from moderate to very low and was low to very low for all observational studies. There is a paucity of high-quality evidence to guide the pharmacotherapy of TAK. Future observational studies should attempt to include appropriate comparator arms. Multicentric, adequately powered RCTs assessing both clinical and angiographic responses are necessary in TAK. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05743-2.

show abstract

“… 8 Other drugs, such as leflunomide, have also been reported to cause quick induction and sustained remission of TA, especially in refractory cases, and therefore, these drugs should be considered to be an alternative treatment for TA. 9 Additional biotherapeutic agents, such as tumor necrosis factor (TNF) inhibitors, have recently been approved for TA treatment. However, neither provide much more benefit than corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

Pathogenesis of liver injury in Takayasu arteritis: advanced understanding leads to new horizons

Kang

Sun

et al. 2020

J Int Med Res

View full text Add to dashboard Cite

Liver injury in Takayasu arteritis (TA) is a rare phenomenon. Most symptoms are nonspecific, and the exact pathogenesis remains to be elucidated. Early diagnosis and new treatment methods are important for an improved prognosis. A summary of the clinical information and mechanistic analyses may contribute to making an early diagnosis and development of new treatment methods. A PubMed search was conducted using the specific key words “Takayasu arteritis” and “liver” or “hepatitis” or “hepatic”. Symptoms and treatment of TA with an accompanying liver injury were reviewed retrospectively. Many factors are presumed to be involved in the mechanism of TA with liver injury, including the immune response, genes, infections, and gut microbiota. There are several lines of evidence indicating that immune dysfunction is the main pathogenic factor that triggers granuloma formation in TA patients. However, the role of genetics and infections has not been fully confirmed. Recently, the gut microbiota has emerged as an essential component in the process. We reviewed in detail the current concepts that support the complex pathogenesis of TA accompanied by liver injury, and we presented recent theories from the literature. Finally, we discussed future research directions of liver injury in TA.

show abstract

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

Cited by 18 publications

References 37 publications

Effectiveness and safety of methotrexate versus leflunomide in 12-month treatment for Takayasu arteritis

Effectiveness and safety of methotrexate versus leflunomide in 12-month treatment for Takayasu arteritis

Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis—a systematic review and meta-analysis

Pathogenesis of liver injury in Takayasu arteritis: advanced understanding leads to new horizons

Contact Info

Product

Resources

About