What is the role of leflunomide in the remission maintenance of granulomatosis with polyangiitis (GPA)?

Updated: Aug 31, 2021
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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Leflunomide (20-30 mg/day) is as effective as methotrexate, but it is associated with more adverse effects. [9] Leflunomide targets T cells by inhibiting the mitochondrial enzyme dihydroorotate dehydrogenase and thus limits pyrimidine synthesis. It is used in the treatment of rheumatoid arthritis. Leflunomide is metabolized by the liver and thus may be used in patients with renal insufficiency.

Because leflunomide has been reported to be associated with increased peripheral neuropathy symptoms, physicians should be aware that the development of neurologic symptoms could represent either a disease flare or an adverse medication effect. [50]

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