TY - JOUR T1 - Combination leflunomide and methotrexate (MTX) therapy for patients with active rheumatoid arthritis failing MTX monotherapy: open-label extension of a randomized, double-blind, placebo controlled trial. JF - The Journal of Rheumatology JO - J Rheumatol SP - 1521 LP - 1531 VL - 31 IS - 8 AU - Joel Kremer AU - Mark Genovese AU - Grant W Cannon AU - Jacques Caldwell AU - John Cush AU - Daniel E Furst AU - Michael Luggen AU - Ed Keystone AU - Joan Bathon AU - Arthur Kavanaugh AU - Eric Ruderman AU - Patricia Coleman AU - David Curtis AU - Elliott Kopp AU - Seth Kantor AU - Michael Weisman AU - Jonathan Waltuck AU - Herbert B Lindsley AU - Joseph Markenson AU - Bruce Crawford AU - Indra Fernando AU - Karen Simpson AU - Vibeke Strand Y1 - 2004/08/01 UR - http://www.jrheum.org/content/31/8/1521.abstract N2 - OBJECTIVE: To obtain additional safety and efficacy data on leflunomide (LEF) treatment in combination with methotrexate (MTX) therapy in an open-label extension study in patients with rheumatoid arthritis (RA). METHODS: Following a 24 week, randomized, double-blind trial of adding placebo (PLA) or LEF to stable MTX therapy, patients could enter a 24 week extension. Subjects randomized to LEF and MTX continued treatment [(LEF/LEF) + MTX]. Subjects randomized to PLA and MTX switched to LEF (10 mg/day, no loading dose) and MTX [(PLA/LEF) + MTX]. The double-blind regarding initial randomization was maintained. RESULTS: For subjects in the extension phase, American College of Rheumatology 20% (ACR20) responder rates for the (LEF/LEF) + MTX group were maintained from Week 24 (57/96, 59.4%) to Week 48 (53/96, 55.2%). ACR20 responder rates improved in patients switched to LEF from PLA at Week 24 [(PLA/LEF) + MTX] from 25.0% (24/96) at Week 24 to 57.3% (55/96) at Week 48. Patients in the extension who switched from PLA to LEF without a loading dose exhibited a lower incidence of elevated transaminases compared to patients initially randomized to LEF. Diarrhea and nausea were less frequent during the open-label extension in patients who did not receive a LEF loading dose. CONCLUSION: Response to therapy was maintained to 48 weeks of treatment in patients who continued to receive LEF and MTX during the extension. Importantly, ACR20 response rates after 24 weeks of LEF therapy were similar between patients switched from PLA to LEF without loading dose, and those who received a loading does of LEF (100 mg/day x 2 days) at randomization. Fewer adverse events were reported in patients switched to LEF without a loading dose. ER -