Generic placeholder image

Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Onset of Hypertension in Leflunamide Treated Low Socioeconomic Rheumatoid Arthritis Patients: An Unseen Iceberg

Author(s): Muhammad Ishaq, Salma Razzaque, Fadieleh Shohail, Ajeet Kumar and Jibran Sualeh Muhammad*

Volume 15, Issue 3, 2019

Page: [242 - 245] Pages: 4

DOI: 10.2174/1573397114666171227211048

Price: $65


Objective: To determine the frequency of new-onset hypertension in patients with Rheumatoid arthritis taking leflunomide, in comparison with methotrexate in Asian setting.

Material and Methods: Perspective case-control study was conducted in 2014 in a tertiary care hospital located in Karachi, Pakistan. Adult patients, having rheumatoid arthritis were randomly prescribed leflunomide or methotrexate. Patients having chronic hypertension, proteinuria and chronic kidney disease were excluded. Patients were monthly followed for blood pressure and heart rate measurements. Hypertension was defined using JNC 7 criteria.

Results: Out of 144 patients enrolled, 80 patients received Leflunomide while 64 were started on methotrexate. Mean systolic blood pressure in leflunomide group at the start and at the end of study was 108.5 and 135.4mmHg, respectively while in methotrexate group, mean systolic BP was 109.8 and 110.5 mmhg, respectively. After one year follow up, 33 out of 80 (41%) patients were receiving leflunomide had pre-hypertension or hypertension, while only 3 out of 64 patients (4.7%) were receiving methotrexate had hypertension.

Conclusion: Risk of developing hypertension in patient receiving Leflunomide is much higher in Asian population like Pakistan as compared to western population.

Keywords: Hypertension, leflunomide, rheumatoid arthritis, methotrexate, patients, proteinuria.

Ding CZ, Yao Y, Feng XB, Fang Y, Zhao C, Wang Y. Clinical analysis of chinese patients with rheumatoid arthritis treated with leflunomide and methotrexate combined with different dosages of glucocorticoid. Curr Ther Res Clin Exp 2012; 73(4-5): 123-33.
[] [PMID: 24653514]
Dougados M, Emery P, Lemmel EM, Zerbini CA, Brin S, van Riel P. When a DMARD fails, should patients switch to sulfasalazine or add sulfasalazine to continuing leflunomide? Ann Rheum Dis 2005; 64(1): 44-51.
[] [PMID: 15271770]
Chung CP, Oeser A, Raggi P, et al. Increased coronary-artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors. Arthritis Rheum 2005; 52(10): 3045-53.
[] [PMID: 16200609]
Serelis J, Panagiotakos DB, Mavrommati M, Skopouli FN. Cardiovascular disease is related to hypertension in patients with rheumatoid arthritis: a Greek cohort study. J Rheumatol 2011; 38(2): 236-41.
[] [PMID: 21078723]
Kellner H, Bornholdt K, Hein G. Leflunomide in the treatment of patients with early rheumatoid arthritis--results of a prospective non-interventional study. Clin Rheumatol 2010; 29(8): 913-20.
[] [PMID: 20496042]
Smolen JS, Kalden JR, Scott DL, et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. Lancet 1999; 353(9149): 259-66.
[] [PMID: 9929017]
Rozman B. Clinical experience with leflunomide in rheumatoid arthritis. Leflunomide Investigators’ Group. J Rheumatol Suppl 1998; 53: 27-32.
[PMID: 9666415]
Rozman B, Praprotnik S, Logar D, et al. Leflunomide and hypertension. Ann Rheum Dis 2002; 61(6): 567-9.
[] [PMID: 12006342]
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62(9): 2569-81.
[] [PMID: 20872595]
Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289(19): 2560-72.
[] [PMID: 12748199]
Wiacek R, Kolossa K, Jankowski T, et al. The efficacy and safety of leflunomide in patients with active rheumatoid arthritis. Adv Clin Exp Med 2012; 21(3): 337-42.
[PMID: 23214197]
Cohen S, Cannon GW, Schiff M, et al. Two-year, blinded, randomized, controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate. Arthritis Rheum 2001; 44(9): 1984-92.
[<1984:AID-ART346>3.0.CO;2-B] [PMID: 11592358]
Wiacek R, Kolossa K, Jankowski T, et al. The efficacy and safety of leflunomide in patients with active rheumatoid arthritis. Adv Clin Exp Med 2012; 21(3): 337-42.
[PMID: 23214197]
Ishaq M, Muhammad JS, Hameed K, Mirza AI. Leflunomide or methotrexate? Comparison of clinical efficacy and safety in low socio-economic rheumatoid arthritis patients. Mod Rheumatol 2011; 21(4): 375-80.
[] [PMID: 21229373]
Ahmad NM, Farman S, Saeed MA, Hameed R, Umair M, Ghafoor E. Leflunomide in Pakistani patients with rheumatoid arthritis: prospective study in daily rheumatology practice. Int J Rheum Dis 2011; 14(1): 48-54.
[] [PMID: 21303481]
Antony T, Jose VM, Paul BJ, Thomas T. Efficacy and safety of leflunomide alone and in combination with methotrexate in the treatment of refractory rheumatoid arthritis. Indian J Med Sci 2006; 60(8): 318-26.
[] [PMID: 16864918]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy