Effectiveness of Combination of Leflunomide and Methotrexate Compared to Etanercept in the Treatment of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Context: Rheumatoid arthritis (RA) is a chronic progressive systemic inflammatory condition, which affects mainly the joint synovial and does not have a definitive treatment. Data was collected using the American College of Rheumatology (ACR) score, and different levels of improvement were shown as ACR20, ACR50, and ACR70. The aim of this study was to compare the effectiveness of combination of leflunomide and methotrexate (LEF + MTX) to etanercept (ETN).

Methods: This systematic review was performed to evaluate the effectiveness of LEF + MTX in comparison with ETN. Electronic databases, including cochrane, PubMed, Scopus, and CRD, were searched up to December 2015. Quality assessment was conducted by the Jadad scale and the Cochrane Collaboration’s tools. Meta-analysis was conducted for effective outcomes of the included studies. Effectiveness was measured by ACR. This review was updated up to January 2019.

Results: Overall, 2780 eligible articles were retrieved, five of which were eligible for inclusion. Effectiveness outcomes showed an improvement in ACR criteria. Differences in the improvement of ACR70, ACR50, and ACR20 criteria in LEF + MTX groups compared to placebo groups were reported 0.78%, 20%, and 27%, respectively, and these differences compared to ETN groups were respectively 0.003%, 21.93%, and 32%.

Conclusions: Combination of leflunomide and methotrexate is effective, and it can be used as before biomedical medications such as etanercept, as it is more cost-effective.