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ARAVA - GENERIC
(generic name: Leflunomide)
Manufacturer: Sanofi-Aventis |
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Reviews |
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Arava - generic |
J Eur Acad Dermatol Venereol. 2005
Mar;19(2):243-6.
Successful treatment of a leg ulcer occurring in a rheumatoid
arthritis patient under leflunomide therapy.
Knab J, Goos M, Dissemond J.
Department of Dermatology, University of Essen, Germany.
ABSTRACT Objective We report the case of a leg ulcer in a rheumatoid arthritis
(RA) patient under treatment with leflunomide, discuss the influence of
the drug on the aetiopathogenesis of the ulcer and describe its successful
treatment. Case summary A 68-year-old woman with a 12-year history of RA
developed a leg ulcer after 4 months of leflunomide treatment. Other ulcerogenic
factors were ruled out. There were some clinical hints for rheumatoid vasculitis.
The ulcer was resistant to ambulant conservative phase adapted wound bed
preparation and a split skin transplantation failed. After omission of leflunomide
and washout procedure with cholestyramine a second split skin transplantation
resulted in complete healing. Discussion Leflunomide inhibits the division
of activated T cells and thus inhibits among others the production of proinflammatory
cytokines and the adhesion of cells to the endothelium. These mechanisms
may partly explain the possible influence of leflunomide on the perpetuation
of the ulcer. Until now, occurrence of vasculitis and leg ulcers has been
described in one case each for the novel immunomodulator leflunomide. No
successful treatment of a leg ulcer under leflunomide has been described
yet. Omission of leflunomide and a washout treatment in our case led to
a complete healing. This may indicate a critical role of leflunomide in
the maintenance of this slow healing ulcer. Conclusions An association between
leflunomide intake, occurrence of leg ulcers in RA patients and delayed
wound healing should be considered.
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Ann Pharmacother. 2005 Mar 1.
Leflunomide and Azathioprine Combination in Refractory
Adult-Onset Still's Disease (April).
Cefle A.
Chief of Rheumatology, Medical Faculty, Department of Internal Medicine,
Division of Rheumatology, Kocaeli University, Kocaeli, Turkey.
OBJECTIVE: To present a case of Adult-onset Still's disease (ASD) in a patient
who was successfully treated with leflunomide and azathioprine. CASE SUMMARY:
A 24-year-old woman with ASD was initially treated with indomethacin, corticosteroids,
and hydroxychloroquine; there was no clinical improvement. Methotrexate
was added to the regimen, followed by azathioprine. The patient still experienced
disease flares with this treatment, and cyclophosphamide was started. However,
because of persisting disease activity, leflunomide combined with azathioprine
was given. Only on this regimen was complete disease control achieved, with
a normal erythrocyte sedimentation rate as well as normal C-reactive protein
and ferritin levels. No recurrences or adverse effects attributable to leflunomide
or azathioprine were observed at the one-year follow-up. DISCUSSION: Clinical
experience concerning leflunomide and azathioprine combination in ASD is
limited. This combination may be modifying the clinical expression of ASD
through its effects on T lymphocyte clonal expansion and production of proinflammatory
cytokines. CONCLUSIONS: Leflunomide combined with azathioprine appears to
be an effective and safe treatment of ASD. |
| Transplantation. 2005
Jan 27;79(2):135-41.
Effects of a short course of leflunomide on T-independent
B-lymphocyte xenoreactivity and on susceptibility of xenografts to acute
or chronic rejection.
Yan Y, Verbeken E, Yu L, Rutgeerts O, Goebels J, Segers
C, Lin Y, Waer M.
Laboratory for Experimental Transplantation, University of Leuven,
Herestraat 49, Leuven, B-3000, Belgium.
BACKGROUND: Leflunomide is a novel immunosuppressive agent with promising
activity for xenotransplantation. It is not clear yet which mechanisms
of action of leflunomide are responsible for that. METHODS: In a hamster-to-C57BL/6
nude mouse heart transplantation model, a 2-week course of leflunomide
was used after transplantation or for pretreating donors. Nontolerant
B lymphocytes were transferred to recipients after transplantation of
first or second xenogeneic heart grafts that were transplanted with or
without leflunomide treatment. RESULTS: Hamster xenogeneic hearts transplanted
into athymic C57BL/6 nude mice receiving leflunomide did not induce immunoglobulin
(Ig) M xenoantibodies (XAb) and survived without signs of chronic rejection.
Second xenogeneic hearts transplanted 4 weeks after withdrawal of leflunomide
survived without induction of XAb but developed chronic vascular lesions.
After injection of naive B lymphocytes at 6 weeks after grafting a first
or second hamster heart, only in the latter case were XAb induced. These
were deposited in, and provoked acute rejection of, only the second grafts.
Pretreatment of donors with leflunomide decreased the ex vivo xenoantibody
deposition on the xenogeneic heart endothelia. CONCLUSIONS: A short posttransplant
course of leflunomide induces T-independent B-lymphocyte xenotolerance.
Leflunomide treatment also influences xenoantigen expression, as nontolerant
B lymphocytes provoke IgM XAb formation and rejection of only second xenografts
(transplanted without leflunomide) and not of first xenografts (transplanted
with leflunomide treatment). The ex vivo experiments that show that XAb
deposition is decreased in leflunomide-pretreated xenografts further confirm
this. The latter may also explain the resistance of first and not second
xenografts against chronic rejection. |
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Drug information |
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| GENERIC NAME: leflunomide
BRAND NAME: Arava
DRUG CLASS AND MECHANISM: Leflunomide is an oral, disease-modifying
drug that is used in the treatment of rheumatoid arthritis. Leflunomide
reduces inflammation in the joints that is responsible for both the symptoms
of rheumatoid arthritis and the destruction of joints. This reduces symptoms
as well as the progressive deformities of the joints caused by the arthritis.
Leflunomide reduces inflammation by suppressing the activity of immune
cells responsible for the inflammation. Leflunomide suppresses immune
cells by inhibiting dihydroorotate dehydrogenase, an enzyme that is necessary
for the production of DNA and RNA. Without DNA and RNA the immune cells
(and most other types of cells) cannot multiply or function (or exist).
Because of its unique and different mechanism of action, leflunomide is
of value when added to other medications used for treating rheumatoid
arthritis. Leflunomide was approved by the FDA in September, 1998.
PREPARATIONS: 10, 20, and 100 mg tablets
STORAGE: Leflunomide should be stored at room temperature
15-30°C (59-86°F).
PRESCRIBED FOR: Leflunomide is used for the treatment
of active rheumatoid arthritis in adults. It reduces the signs, symptoms
and joint damage caused by rheumatoid arthritis.
DOSING: The usual dose is 100 mg daily for the first
3 days, followed by 20 mg daily. Doctors may reduce the dose to 10 mg
daily if side effects appear. It may require up to four weeks of therapy
before improvement of the arthritis are seen. It is not known if ingestion
of food or alcohol affects the absorption or action of leflunomide.
DRUG INTERACTIONS: Cholestyramine and charcoal decrease
the concentration of the active form of leflunomide in the blood probably
by preventing absorption. Rifampin increases the blood concentration of
the active form of leflunomide by 40% probably by increasing the conversion
of leflunomide to its active form. This may increase the side effects
of leflunomide.
PREGNANCY: Leflunomide is harmful to the developing
fetus and should not be used during pregnancy.
NURSING MOTHERS: It is unknown whether leflunomide accumulates
in breast milk. Since leflunomide could cause harm to the infant, women
taking leflunomide should probably refrain from breastfeeding.
SIDE EFFECTS: The most frequently reported side effects
are diarrhea, nausea, headache, rash, itching, loss or thinning of hair
and weight loss. Leflunomide also may cause high blood pressure, chest
pain and abnormal heartbeats. Since leflunomide suppresses the immune
system, it may increase the risk to patients of infections. The most frequently
reported infections involve the respiratory tract. Leflunomide may cause
abnormal liver tests in the blood, suggesting damage to the liver. The
liver tests usually return to normal with continued treatment. The dose
of leflunomide should be reduced if liver tests are persistently greater
than twice the upper limit of normal, and leflunomide should be discontinued
if the levels remain above three times the upper limit of normal despite
a reduction in dose. Leflunomide should not be administered to individuals
with liver problems.
Caution! Before starting
to take this medicine, it is vital that you should consult your doctor!
Do not use it on your own initiative, without medical advice.
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Dosage |
Packing |
Price |
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10 mg |
100 tab |
USD 169.00 |
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20 mg |
100 tab |
USD 229.00 |
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