Efficacy and safety of add-on tacrolimus versus leflunomide in rheumatoid arthritis patients with inadequate response to methotrexate
- Authors
- Shin, Kichul; Baek, Han Joo; Kang, Young Mo; Cha, Hoon-Suk; Kang, Seong Wook; Park, Sung-Hwan; Jun, Jae-Bum; Lee, Yun Jong; Choi, In Ah; Song, Yeong Wook
- Issue Date
- Jun-2019
- Publisher
- WILEY
- Keywords
- methotrexate; non-inferiority; rheumatoid arthritis; tacrolimus
- Citation
- INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, v.22, no.6, pp.1115 - 1122
- Journal Title
- INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES
- Volume
- 22
- Number
- 6
- Start Page
- 1115
- End Page
- 1122
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/1449
- DOI
- 10.1111/1756-185X.13521
- ISSN
- 1756-1841
- Abstract
- Aim To investigate the efficacy and safety of tacrolimus (TAC) versus leflunomide (LEF) when combined with methotrexate (MTX) in rheumatoid arthritis (RA) patients. Method This was a 24-week multi-center, double-blind, randomized, non-inferiority study targeting RA patients with moderate to severe Disease Activity Score of 28 joints (DAS28 > 3.2) who showed inadequate response to MTX. Patients were randomized into TAC or LEF (add-on to MTX) groups. Initial daily doses of TAC and LEF were 1.5 and 10 mg, respectively, for 4 weeks and then doubled until the end of the study. The primary endpoint was DAS28 comparison at 24 weeks. Results Eighty-seven patients were screened in 10 centers and 75 patients were randomized into two groups. Baseline demographics were comparable between TAC + MTX and LEF + MTX groups. The TAC + MTX group was non-inferior to the LEF + MTX group in terms of DAS28 at 24 weeks (mean difference of DAS28: -0.1812, 95% confidence interval: -0.8073, 0.4450). There was a greater number of adverse events in the LEF + MTX group (66 in LEF + MTX and 49 in TAC + MTX). Six patients presented with transaminitis in the LEF + MTX group compared with two patients in the TAC + MTX group. Conclusion The efficacy of TAC combined with MTX was non-inferior to LEF + MTX. It had a reasonable safety profile in RA patients with moderate to severe disease activity (; KCT0000781).
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