Question

Is it advisable to start leflunomide in a patient with systemic lupus erythematosus (SLE) in whom methotrexate had to be stopped because of liver enzyme elevations?

Christian Dequet, MD

Response from Lee S. Simon, MD

No published data are available on the use of leflunomide in patients with SLE. However, I and others have used it for SLE with some success; there is no inherent reason not to do so.

Given the liver enzyme elevations with the methotrexate therapy, one should follow up with regular liver function tests during leflunomide therapy. The white blood cell count should also be monitored carefully.

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