Efficacy and safety of leflunomide in the treatment of plaque type psoriasis
Keywords:
Leflunomide, methotrexate, plaque psoriasisAbstract
Background Psoriasis is universal in occurrence, representing a lifelong burden for affected patients. Various modalities of treatment are available and new drugs are coming up but toxicity and cost of the drug is very important. Leflunomide is an immunomodulatory and anti- inflammatory drug effective in chronic plaque type Psoriasis. Objectives To assess the efficacy and safety of leflunomide in the treatment of chronic plaque type psoriasis. Patients and methods The prospective controlled randomized study was carried out in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2005 to June 2006 over a period of one and half years. Forty patients with moderate to severe plaque-type psoriasis patients were treated in two groups (A & B). In group A, 20 patients were treated with leflunomide 100mg daily for 3 days, then 20mg daily for 12 weeks and in group B 7.5mg methotrexate was given in 3 divided doses 12 hourly for 12 weeks. The effectiveness and side effects were assessed at 4th week and 12th week of the study on the basis of psoriasis area and severity index (PASI). Result At the final follow up mean percentage of improvement of psoriasis was observed based on PASI score reduction. It was 52.14% in group A and 42.11% in group B. Conclusion From the current study it may be suggested that leflunomide is effective and well tolerated agent and has some advantages over methotrexate in the treatment of psoriasisReferences
James WD, Berger TG, Elston DM, editors. Andrew's Diseases of the skin Clinical Dermatology, 10th edition. Canada: Saunders Elsevier; 2006, p 193-201.
Asadullah K, Docke WD, Ebeling M et al. Interleukin 10 treatment of psoriasis. Arch Dermatol 1999; 135: 187-92.
Tlacuilo-Parra JA, Guevara-Gutierrez E, Rodriguez-Castellanos MA et al. Leflunomide in the treatment of psoriasis: results of a phase II open trial’. Br J Dermatol 2004; 150: 970-6.
Gottlieb AB, Chaudhari U, Mulcahy LD et al. Infliximab monotherpy provides rapid and sustained benefit for plaque-type psoriasis. J Am Acad Dermatol 2003; 48: 829-35.
Saporita FC, Menter MA. Methotrexate and psoriasis in the ere of new biologic agents, J Am Acad Dermatol 2004; 50: 301-9.
Christophers E, Mrowietz U. Psoriasis. In: Freedberg, IM, Eisen AZ, Wolff K et al., eds. Fitzpatrick’s Dermatology in General Medicine, 6th edn, New York: McGraw-Hill, 2003. P. 407-435
Shupack J, Abel E, Bauer E et al. Cyclosporine as maintenance therapy in patients with severe psoriasis. J Am Acad Dermatol 1997; 36: 423-32.
Carlin CS, Feldman SR, Krueger JG et al. A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant end point in the assessment of psoriasis. J Am Acad Dermatol 2004; 50: 859-66.
Schiff MH, Strand V, Oed C, Loew-Friedrich I. Leflunomide: efficacy and safety in clinical trials for the treatment of rheumatoid arthritis. Drugs Today 2000; 36: 383-94.