Richard Conway1, Candice Low2, Robert J Coughlan2, Martin J O'Donnell2, John J Carey2. 1. From the Department of Rheumatology, Galway University Hospitals, Merlin Park; the National University of Ireland, Galway; Department of Rheumatology, Connolly Hospital Blanchardstown, Dublin, Ireland.R. Conway, MB, Rheumatology Specialist Registrar, Department of Rheumatology, Galway University Hospitals, Merlin Park, and the National University of Ireland; C. Low, MB, Rheumatology Registrar, Department of Rheumatology, Connolly Hospital Blanchardstown; R.J. Coughlan, MD, Consultant Rheumatologist, Department of Rheumatology, Galway University Hospitals, Merlin Park; M.J. O'Donnell, PhD, Professor, National University of Ireland; J.J. Carey, MS, Professor, Department of Rheumatology, Galway University Hospitals, Merlin Park, and the National University of Ireland. drrichardconway@gmail.com. 2. From the Department of Rheumatology, Galway University Hospitals, Merlin Park; the National University of Ireland, Galway; Department of Rheumatology, Connolly Hospital Blanchardstown, Dublin, Ireland.R. Conway, MB, Rheumatology Specialist Registrar, Department of Rheumatology, Galway University Hospitals, Merlin Park, and the National University of Ireland; C. Low, MB, Rheumatology Registrar, Department of Rheumatology, Connolly Hospital Blanchardstown; R.J. Coughlan, MD, Consultant Rheumatologist, Department of Rheumatology, Galway University Hospitals, Merlin Park; M.J. O'Donnell, PhD, Professor, National University of Ireland; J.J. Carey, MS, Professor, Department of Rheumatology, Galway University Hospitals, Merlin Park, and the National University of Ireland.
Abstract
OBJECTIVE: To evaluate the relative risk (RR) of pulmonary disease among patients with rheumatoid arthritis (RA) treated with leflunomide (LEF). METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to April 15, 2014. We included double-blind randomized controlled trials (RCT) of LEF versus placebo or active comparator agents in adults with RA. Studies with fewer than 50 subjects or shorter than 12 weeks were excluded. Two investigators independently searched both databases. All authors reviewed selected studies. We compared RR differences using the Mantel-Haenszel random-effects method to assess total respiratory adverse events, infectious respiratory adverse events, noninfectious respiratory adverse events, interstitial lung disease, and death. RESULTS: Our literature search returned 5673 results. A total of 8 studies, 4 with placebo comparators, met our inclusion criteria. There were 708 respiratory adverse events documented in 4579 participants. Six cases of pneumonitis occurred, all in the comparator group. Four pulmonary deaths were reported, none in the LEF group. LEF was not associated with an increased risk of total adverse respiratory events (RR 0.99, 95% CI 0.56-1.78) or infectious respiratory adverse events (RR 1.02, 95% CI 0.58-1.82). LEF was associated with a decreased risk of noninfectious respiratory adverse events (RR 0.64, 95% CI 0.41-0.97). CONCLUSION: Our study found no evidence of increased respiratory adverse events in RCT of LEF treatment.
OBJECTIVE: To evaluate the relative risk (RR) of pulmonary disease among patients with rheumatoid arthritis (RA) treated with leflunomide (LEF). METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to April 15, 2014. We included double-blind randomized controlled trials (RCT) of LEF versus placebo or active comparator agents in adults with RA. Studies with fewer than 50 subjects or shorter than 12 weeks were excluded. Two investigators independently searched both databases. All authors reviewed selected studies. We compared RR differences using the Mantel-Haenszel random-effects method to assess total respiratory adverse events, infectious respiratory adverse events, noninfectious respiratory adverse events, interstitial lung disease, and death. RESULTS: Our literature search returned 5673 results. A total of 8 studies, 4 with placebo comparators, met our inclusion criteria. There were 708 respiratory adverse events documented in 4579 participants. Six cases of pneumonitis occurred, all in the comparator group. Four pulmonary deaths were reported, none in the LEF group. LEF was not associated with an increased risk of total adverse respiratory events (RR 0.99, 95% CI 0.56-1.78) or infectious respiratory adverse events (RR 1.02, 95% CI 0.58-1.82). LEF was associated with a decreased risk of noninfectious respiratory adverse events (RR 0.64, 95% CI 0.41-0.97). CONCLUSION: Our study found no evidence of increased respiratory adverse events in RCT of LEF treatment.
Authors: Jorge A Zamora-Legoff; Megan L Krause; Cynthia S Crowson; Jay H Ryu; Eric L Matteson Journal: Clin Rheumatol Date: 2016-07-22 Impact factor: 2.980
Authors: Sarah Skeoch; Nicholas Weatherley; Andrew J Swift; Alexander Oldroyd; Christopher Johns; Conal Hayton; Alessandro Giollo; James M Wild; John C Waterton; Maya Buch; Kim Linton; Ian N Bruce; Colm Leonard; Stephen Bianchi; Nazia Chaudhuri Journal: J Clin Med Date: 2018-10-15 Impact factor: 4.241