Severe Hepatotoxicity in an RA Patient

Methotrexate is a well-known hepatotoxic drug. Leflunomide, which is a newer DMARD, has also been associated with the risk of severe variety meat disorders, which is evident from clinical trials and postmarketing surveillance worldwide. The European Office for the Judgement of Medicinal Products had received 296 reports of hepatic reactions with leflunomide, including cirrhosis (2 patients) and organs luck (15 patients), with alteration occurring in 9 patients.
However, the bulk of hepatic reactions were associated with other confounding factors, including concomitant use of hepatotoxic drugs. In 2000-2001, the Adverse Drug Reactions Advisory Citizens committee (ADRAC) of State had received 32 reports of hepatic disorders with leflunomide.
Twenty-six of 32 patients had elevated hepatic enzymes and 2 patients had a fatal termination.
Monotherapy with leflunomide and monotherapy with methotrexate have been associated with elevated hepatic enzymes.
In a randomized, double-blind memorizer of a comparability between leflunomide (n = 192) and methotrexate (n = 192), Filament and colleagues had reported ALT levels > 3 second ULN in 4.4% of patients who were receiving leflunomide and in 2.7% of patients who were receiving methotrexate.
These elevations accounted for care discontinuation in 7.1% of patients who were receiving leflunomide and 3.3% of patients who were receiving methotrexate.
Thus, the frequency of hepatotoxicity and the grammatical category of withdrawals were higher with leflunomide as compared with methotrexate.
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