From the Guidelines
Leflunomide is not recommended as a first-line treatment for Mixed Connective Tissue Disease (MCTD) due to its potential to worsen or develop interstitial lung disease (ILD) and lack of clear benefit for ILD outcomes, as suggested by the 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) guideline 1. For patients with MCTD, the initial treatment approach typically involves hydroxychloroquine (200-400mg daily) as the first-line immunomodulatory medication, often combined with low-dose corticosteroids (prednisone 5-15mg daily) during disease flares.
- If symptoms persist, methotrexate (starting at 7.5-10mg weekly and potentially increasing to 20-25mg weekly) or mycophenolate mofetil (1-3g daily in divided doses) are usually considered as second-line agents.
- Leflunomide (10-20mg daily) may be considered as an alternative when these medications are contraindicated or ineffective, particularly for patients with prominent arthritis symptoms, but with careful monitoring for potential side effects including hepatotoxicity, bone marrow suppression, and teratogenicity, as noted in the guideline 1. Key considerations in the management of MCTD include:
- Regular blood tests (CBC, liver function) every 2-4 weeks initially and then every 8-12 weeks are necessary for patients on leflunomide.
- The medication's long half-life means that cholestyramine washout may be needed if rapid drug elimination becomes necessary.
- Treatment should be tailored to the predominant disease manifestations and managed by specialists experienced with connective tissue diseases, taking into account the complex nature of MCTD with its overlapping features of lupus, scleroderma, and myositis, as emphasized in the guideline 1.
From the Research
MCTD Treatment
- The treatment of Mixed Connective Tissue Disease (MCTD) often involves the use of disease-modifying antirheumatic drugs (DMARDs) and immunosuppressants (IS) 2.
- Hydroxychloroquine (HCQ) and glucocorticoids (GC) are commonly used as the cornerstone of MCTD treatment, and are sufficient to control disease manifestations in nearly half of the patients 2.
- DMARDs and IS, including anti-B cell therapeutics, are more frequently prescribed in patients with musculoskeletal involvement, interstitial lung disease (ILD), and/or pulmonary arterial hypertension (PAH) 2.
Lufenomide in MCTD Treatment
- There is no direct evidence in the provided studies regarding the use of Lufenomide in MCTD treatment.
- However, the use of DMARDs such as methotrexate has been discussed in the treatment of MCTD and other connective tissue diseases 3.
MCTD Management
- MCTD is a complex disease that requires specific management, and its treatment is currently lacking formal recommendations 4, 5.
- Early diagnosis, epidemiological data, assessment of burden of disease, and quality of life (QOL) aspects are among the unmet needs identified by patients 5.
- The development of clinical practice guidelines (CPGs) for MCTD diagnosis, initial and follow-up evaluations, and treatment is necessary 5.