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Leflunomide is a medication used in the management and treatment of rheumatoid arthritis. It is in the non-biological DMARDs class of medications. This activity reviews the indications, action, and contraindications for leflunomide as a valuable agent in treating and managing rheumatoid arthritis. This activity will highlight the mechanism of action, adverse event profile, and other key factors of leflunomide use in a clinical setting, pertinent to members of the interprofessional team in the care of patients with rheumatoid arthritis and related conditions. Objectives: Identify the mechanism of action of leflunomide. Describe the potential adverse effects of leflunomide. Review the appropriate monitoring of leflunomide. Summarize some interprofessional team strategies for improving care coordination and communication to advance leflunomide use in the care of rheumatoid arthritis and improve outcomes. Access free multiple choice questions on this topic.

Cholestyramine Four grams of cholestyramine every 6 hours for 14 days is the recommended intervention for wash-out therapy due to the long half-life of leflunomide.[11] Leflunomide toxicity can affect the liver by causing acute drug-induced hepatic injury and affect the pulmonary system through pneumonitis and interstitial lung disease. During these complications, discontinuation of leflunomide and empirical cholestyramine wash-out therapy is recommended for toxicity.[22][23] Leflunomide causes aryl hydrocarbon receptor signaling, which acts on pulmonary and hepatic CYP1A enzymes.[24] Excess aryl hydrocarbon receptor signaling leads to several pathologic states in the lung and liver.[24] Pancytopenia can also result due to leflunomide toxicity. The treatment goal is the same as drug-induced hepatic injury and drug-induced pneumonitis, which is leflunomide-eliminating cholestyramine treatment.[13]

Leflunomide is an FDA-approved medication indicated for the treatment of rheumatoid arthritis. Managing the treatment of patients prescribed leflunomide requires excellent communication between the patient and professional healthcare providers. These providers need to function as an interprofessional team to include a primary care physician, a rheumatologist, a nurse, and a pharmacist. The primary care physicians and rheumatologists necessitate excellent patient rapport, so the patient fully understands the importance of medication compliance and education on the treatment and illness. It is vital to be engaged in the patient's care, so relapses, remissions, and disability do not occur long term. The primary care and specialist should be familiar with leflunomide, its implications, and adverse effects. The patients prescribed leflunomide need routine checkups to observe if the medication is in an optimal range and the patient is not experiencing elevation in liver enzymes. Collective decision-making and interprofessional communication are necessary elements to enhance patient-centered care and achieve the desired outcome. Without the proper care and communication of an interprofessional team of healthcare professionals, the risk of adverse events and leflunomide toxicity, including drug-induced hepatitis, drug-induced pneumonitis, pancytopenia, and harm to the fetus during pregnancy, is highly likely. An interprofessional healthcare team working across disciplinary lines providing an integrated, evidence-based strategy to patients receiving treatment with leflunomide will help deliver the best possible outcomes.[25]