Abstract:

Objective: Conventional synthetic disease-modifying antirheumatic drugs are used alone or in combination to treat inflammatory arthritis. The risk of serious side effects may also increase with the combination of methotrexate and leflunomide (MTX + LEF), which is used for better clinical response. Materials and Methods: The data of 107 patients who received MTX + LEF treatment for inflammatory arthritis were retrospectively reviewed. Results: The mean age was 50 (±13), and the median disease duration was five years. Three months after the initiation of MTX + LEF treatment, 76.6% of patients continued treatment in remission. The mean duration of drug survival for these patients was 30 months. The most important reasons for drug discontinuation in the first three months after treatment initiation were primary inefficacy and >2-fold increase in transaminases, whereas remission, patient decision, or secondary non-response were found in long-term follow-up. The frequency of transaminase elevations was 9.3% (10/107), and 70% of these were observed in the first three months of treatment, and all resolved after drug discontinuation. The incidence of serious infections was 6.5% (7/107), and mortality was not observed; the incidence of serious infections was higher in the elderly (p=0.002). The MTX + LEF continuation rate was 45% at the last visit of the patients included in the study. Conclusion: The MTX + LEF combination is a safe and effective option for achieving remission when used considering old age and comorbidities; It is important to closely monitor transaminase levels, especially in the first three months.

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