Leflunomide-induced interstitial lung disease (a systematic review)

Rishi Raj*, K. Nugent

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Leflunomide, a disease modifying anti-rheumatic drug in use since 1998, causes interstitial lung disease (ILD) and other pulmonary complications. Methods: We undertook a systematic review of literature of PubMed (March 2013) to identify the published literature pertaining to pulmonary toxicity associated with leflunomide. Results: We identified 41 relevant articles detailing four population studies and case reports/series on an additional 42 patients. Available data were reviewed and summarized. Conclusions: Leflunomide can cause ILD. Most of these patients present within three months of starting leflunomide with acute symptoms for a week or less. Bilateral ground glass opacities and diffuse alveolar damage are the most common radiologic and histopathologic findings, respectively. Patients with pre-existing ILD are particularly at risk for this complication, and leflunomide should be avoided in this population. Activated charcoal and cholestyramine significantly decrease the half-life of the drug because of its enterohepatic circulation and should be considered in cases with acute toxicity.

Original languageEnglish (US)
Pages (from-to)167-176
Number of pages10
JournalSarcoidosis Vasculitis and Diffuse Lung Diseases
Volume30
Issue number3
StatePublished - Jan 1 2013

Fingerprint

leflunomide
Interstitial Lung Diseases
Enterohepatic Circulation
Cholestyramine Resin
Lung
Antirheumatic Agents
Charcoal
PubMed
Population
Glass
Half-Life

Keywords

  • Drug induced
  • Drug toxicity
  • Interstitial lung disease
  • Leflunomide

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Internal Medicine
  • Medicine(all)

Cite this

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Leflunomide-induced interstitial lung disease (a systematic review). / Raj, Rishi; Nugent, K.

In: Sarcoidosis Vasculitis and Diffuse Lung Diseases, Vol. 30, No. 3, 01.01.2013, p. 167-176.

Research output: Contribution to journalArticle

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AU - Nugent, K.

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AB - Background: Leflunomide, a disease modifying anti-rheumatic drug in use since 1998, causes interstitial lung disease (ILD) and other pulmonary complications. Methods: We undertook a systematic review of literature of PubMed (March 2013) to identify the published literature pertaining to pulmonary toxicity associated with leflunomide. Results: We identified 41 relevant articles detailing four population studies and case reports/series on an additional 42 patients. Available data were reviewed and summarized. Conclusions: Leflunomide can cause ILD. Most of these patients present within three months of starting leflunomide with acute symptoms for a week or less. Bilateral ground glass opacities and diffuse alveolar damage are the most common radiologic and histopathologic findings, respectively. Patients with pre-existing ILD are particularly at risk for this complication, and leflunomide should be avoided in this population. Activated charcoal and cholestyramine significantly decrease the half-life of the drug because of its enterohepatic circulation and should be considered in cases with acute toxicity.

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