medwireNews: Results of a Sri Lankan trial suggest that leflunomide and low-dose rituximab have comparable efficacy when used in combination with methotrexate for the treatment of patients with rheumatoid arthritis (RA) refractory to first-line non-biologic disease modifying antirheumatic drugs.
The researchers found that 84% of 19 patients who were randomly assigned to receive treatment with 10–20 mg daily leflunomide together with methotrexate experienced at least a 20% improvement in ACR criteria at week 24, compared with 85% of 20 patients receiving two 500 mg infusions of rituximab on days 1 and 15 alongside methotrexate, a nonsignificant difference.
“The trial data has significant beneficial cost implications for treatment of patients with refractory rheumatoid arthritis,” say Priyadharshini Galappatthy (University of Colombo, Sri Lanka) and fellow researchers, noting that the low-dose rituximab regimen costs less than the usual 1000 mg dose, and that the “leflunomide-methotrexate combination is much cheaper compared to low-dose rituximab-methotrexate combination.”
Lower cost regimens “should enable more patients with refractory rheumatoid arthritis to be treated successfully in resource-limited settings,” they add.
Participants in both treatment groups experienced a significant reduction in memory B cells and pneumococcal antibody levels from baseline to week 24, and those in the rituximab group also had significant reductions in B cell levels.
These “[c]hanges in immune parameters with leflunomide are novel and need further characterization,” conclude the researchers in BMC Musculoskeletal Disorders.
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