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There have been numerous reports of interstitial lung disease associated with the use of the new disease modifying anti-rheumatic drug leflunomide. This epidemiological study examined the risk of developing interstitial lung disease (ILD) in patients on leflunomide.
Data from 62 734 patients with rheumatoid arthritis were examined in a case-control study. The risk of ILD was not higher for patients on leflunomide provided they had no previous methotrexate use or a history of ILD (relative risk (RR) 1.2, 95% confidence interval (CI) 0.4 to 3.1). There was, however, an increased risk of ILD with leflunomide in patients who did have a history of previous methotrexate use or ILD (RR 2.6, 95% CI 1.2 to 5.6).
The use of leflunomide as a disease modifying anti-rheumatic drug is increasing in patients with rheumatoid arthritis and reports of ILD are rising. Respiratory physicians should be aware of the potential for developing ILD.