Systematic Review and Meta-Analysis of the Efficacy and Safety of Leflunomide and Methotrexate in the Treatment of Rheumatoid Arthritis

The 2019 meta-analysis evaluated the efficacy and safety of leflunomide and methotrexate as first-line treatments for rheumatoid arthritis across 6 trials with 1984 patients. It found that both drugs were similarly effective in achieving ACR 20 response and had comparable effects on tender joint count, physician global assessment, HAQ-Di, and CRP levels. Methotrexate was more effective in reducing swollen joint count, while leflunomide had a higher incidence of increased liver enzymes and methotrexate had more gastrointestinal complaints. The study concluded that both drugs could be used as first-line treatments for RA, despite their different side effect profiles, and called for further research on additional outcomes and economic evaluations.