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ACR 2019 | Daily Highlights
Leflunomide for vasculitis
EFFICACY OF LEFLUNOMID FOR TREATMENT OF VASCULITIS
Abstract: 1704
Authors: Noura Mustapha et al.
Key content:
Case reports and a few clinical trials have suggested a therapeutic role of leflunomide (LEF) in ANCA-associated vasculitis and large vessel vasculitides such as Giant Cell Arteritis. This study aimed at elucidating the role of the steroid-sparing agent LEF.
Patients having received LEF for treatment of their vasculitis were enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Study and in 3 additional centers from the Canadian vasculitis research network (CanVasc). Efficacy was defined as a response to LEF at 6 months after its initiation, with the ability to taper glucocorticoids (GC). The validation of efficacy also required the absence of active disease, corresponding to a Birmingham Vasculitis Activity Score of 0.
Data for 93 patients were analyzed. 45 patients had granulomatosis with polyangiitis (GPA), 8 microscopic polyangiitis (MPA), 12 eosinophilic granulomatosis with polyangiitis (EGPA), 14 giant-cell arteritis (GCA), 9 Takayasu’s arteritis (TAK) and 5 polyarteritis nodosa (PAN). The main reason for initiation of LEF was active disease (89%). LEF was efficacious for remission induction or maintenance at 6 months for 62 (67%) patients (64% with GCA, 89% with TAK, 80% with PAN, 69% with GPA, 33% with EGPA); 20% discontinued LEF before achieving remission because of persistent disease activity. Overall, 22 adverse events led to drug discontinuation in 18 (19%) patients, of which 6 stopped LEF before month 12 and before showing any benefit in 8/12 of these patients.
Relevance:
LEF is shown to be an effective therapeutic option for various vasculitides, especially for nonsevere refractory or relapsing ANCA-associated vasculitis or large-vessel vasculitis, and for maintenance in GPA or MPA. Taken together, LEF appears to play an interesting therapeutic role in vasculitides of very different pathogenesis, it appears to play a role as a steroid-sparing agent.
Zusammenfassung und Kommentar von:
Prof. Dr. Peter Villiger
Bern
