Clinical Efficacy and Safety of Leflunomide in Egyptian Patients with Active Rheumatoid Arthritis: CLEAR Interim Results

Adel El Sayed1 , * Open Modal Abd El-Monim Hilal2 Ahmed Abogamal3 Alaa Labeeb4 Amin Abdel Hamid3 Amira El Gerby2 Ayman Farouk Darwish5 Aziza Sayed Omar6 Dahlia Abdel Mohsen7 Dalia Faiez1 Essan A M Abda8 Fatemah A. Elshabacy9 Manal Tayel10 Mohamed Elwakd11 Mohamed Mortada12 Mohsen H.Elshahaly6 Nevine Mohannad10 Raga A. Kader2 S. Z. Hassan11 Samah A. Elbakry7 Sherif Refaat13 Authors Info & Affiliations
The Open Rheumatology Journal 31 December 2018 RESEARCH ARTICLE DOI: 10.2174/1874312901812010323



Worldwide, leflunomide is a commonly used Disease-Modifying Anti-Rheumatic Drugs (DMARDs). It can be used as a monotherapy or in combination with other DMARDs to inhibit the production of inflammatory cells and accordingly reduce inflammation.


CLEAR is a multi-centric study that aims to assess the clinical efficacy and safety of leflunomide as first-line and/or add-on therapy to other DMARDs with or without steroids in Egyptian patients with active Rheumatoid Arthritis (RA).


Egyptian patients with active RA for whom leflunomide was prescribed at physicians’ discretion were observed for 12 weeks. Clinical Disease Activity Index (CDAI) score, and Health Assessment Questionnaire Disability Index (HAQ-DI) score were acquired thrice during this period. This study was registered on (NCT03599986).


Interim analysis of the data collected from 337 patients (in 21 centers) showed a statistically significant decrease in the mean total CDAI score throughout the first 12 weeks of treatment (p<0.001); as the mean ±SD score decreased from 36.60 ±14.90 at baseline to reach 16.16 ±9.84 at week 12 (% reduction: 61.16 ±14.36). A statistically significant decrease (p<0.001) was also observed in HAQ-DI, as the mean ±SD score decreased from 1.46 ±0.69 at baseline to reach 0.67 ±0.54 at week 12 (% reduction: 56.11 ±27.59).


Results of the interim analysis suggest that treatment of Egyptian patients with active RA with leflunomide (as first-line and/or add-on therapy to other DMARDs with or without steroids) for 12 weeks may be effective in terms of CDAI score and HAQ-DI score reduction and may offer an alternative for patients who experienced resistance, inadequate response or intolerance to other DMARDs.

Keywords: Rheumatoid Arthritis, DMARDs, Leflunomide, CDAI, HAQ-DI, Egypt.
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