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

The systematic review and meta-analysis conducted by Alfaro-Lara et al. in 2019 included 73 trials, but only 6 met the criteria for meta-analysis, involving a total of 1984 patients with rheumatoid arthritis. The study found that leflunomide and methotrexate were equally effective in achieving the American College of Rheumatology (ACR) 20 response, with no significant difference in tender joint count, physician global assessment, Health Assessment Questionnaire Disability Index (HAQ-Di), and serum C-reactive protein (CRP) levels. Methotrexate was more effective in reducing swollen joint count. Leflunomide was associated with a higher frequency of increased liver enzymes, while methotrexate was linked to more gastrointestinal complaints, but there was no difference in the incidence of non-severe infections between the two drugs. The study concluded that both drugs are effective for treating rheumatoid arthritis, with different safety profiles.