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Published Online, 1 March 2005, www.theannals.com, DOI 10.1345/aph.1E425.
 The Annals of Pharmacotherapy: Vol. 39, No. 4, pp. 764-767. DOI 10.1345/aph.1E425
© 2005 Harvey Whitney Books Company.
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Leflunomide and Azathioprine Combination in Refractory Adult-Onset Still's Disease

Ayse Cefle, MD

Assistant Professor, Chief of Rheumatology, Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Kocaeli University, Kocaeli, Turkey

Reprints: Dr. Cefle, Inonu caddesi, Camlik Park sokak, Koru Apartmani 2 / 31, 34734 Sahrayicedid, Istanbul, Turkey, fax 90 262 233 54 61, kcefle{at}hotmail.com

OBJECTIVE: To present a case of Adult-onset Still's disease (ASD) in a patient who was successfully treated with leflunomide and azathioprine.

CASE SUMMARY: A 24-year-old woman with ASD was initially treated with indomethacin, corticosteroids, and hydroxychloroquine; there was no clinical improvement. Methotrexate was added to the regimen, followed by azathioprine. The patient still experienced disease flares with this treatment, and cyclophosphamide was started. However, because of persisting disease activity, leflunomide combined with azathioprine was given. Only on this regimen was complete disease control achieved, with a normal erythrocyte sedimentation rate as well as normal C-reactive protein and ferritin levels. No recurrences or adverse effects attributable to leflunomide or azathioprine were observed at the one-year follow-up.

DISCUSSION: Clinical experience concerning leflunomide and azathioprine combination in ASD is limited. This combination may be modifying the clinical expression of ASD through its effects on T lymphocyte clonal expansion and production of proinflammatory cytokines.

CONCLUSIONS: Leflunomide combined with azathioprine appears to be an effective and safe treatment of ASD.

Key Words: adult-onset, azathioprine, drug resistance, leflunomide, Still's disease

Published Online, March 1, 2005. www.theannals.com, DOI 10.1345/aph.1E425


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M. Sayarlioglu, H. Ucmak, M. Ozkaya, M. A. Ucar, and H. Sayarlioglu
Leflunomide and Methotrexate Combination in Refractory Adult-Onset Still's Disease
Ann. Pharmacother., July 1, 2007; 41(7): 1319 - 1320.
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