Would rounds of prednisone be needed for flares in patients taking leflunomide?

From the Guidelines

Rounds of prednisone may still be needed for flares in patients taking leflunomide, as the medication may not completely prevent all flares. Leflunomide is a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and other autoimmune conditions. While it helps control the underlying disease process, it may not completely prevent all flares.

• The goal of leflunomide therapy is to reduce the frequency and severity of flares, potentially minimizing the need for prednisone over time.
• However, during acute flares, short courses of prednisone (typically 5-60 mg daily for 5-14 days, tapering as symptoms improve) can provide rapid relief of inflammation and pain, as seen in various studies 1.
• The exact dose and duration would be determined by your doctor based on the severity of the flare and your individual circumstances.
• It's also important to note that while prednisone can quickly alleviate symptoms, it should be used sparingly due to potential side effects with long-term use.
• A study from 2020 found that leflunomide can be effective in reducing disease activity, but may not eliminate the need for prednisone entirely 1.
• Another study from 2024 discussed the use of various medications, including leflunomide, in the management of systemic lupus erythematosus, but did not provide direct evidence on the use of prednisone for flares in patients taking leflunomide 1. Always consult with your rheumatologist before starting or adjusting any medication regimen, including the use of prednisone for flares while on leflunomide.

From the Research

Leflunomide and Prednisone Treatment

• The use of leflunomide in patients with rheumatoid arthritis has been shown to be effective in reducing disease activity and improving symptoms 2.
• In some cases, leflunomide may be used in combination with prednisone to achieve better control of the disease 3, 4.
• The dosage of prednisone may be reduced when used in combination with leflunomide, as seen in a study where the median dose of prednisone was reduced from 22.5 mg/day to 7.5 mg/day 3.
• Leflunomide has also been shown to have a steroid-sparing effect, allowing for lower doses of prednisone to be used while still maintaining disease control 4.

Flares and Prednisone Treatment

• In patients taking leflunomide, flares may still occur, and treatment with prednisone may be necessary to control these flares.
• The frequency and severity of flares may be reduced when leflunomide is used in combination with prednisone 3, 4.
• However, the exact protocol for using prednisone to treat flares in patients taking leflunomide is not well established and may vary depending on the individual patient and their specific condition.

Safety and Efficacy

• Leflunomide has been shown to be generally safe and effective in treating various conditions, including rheumatoid arthritis and Takayasu arteritis 2, 3, 4, 5.
• However, as with any medication, there is a risk of adverse effects, and patients should be closely monitored while taking leflunomide.
• The use of leflunomide in combination with prednisone may increase the risk of certain adverse effects, such as infections 5.