Eficacia y seguridad de leflunomida y metotrexato en el tratamiento de artritis reumatoide. Revisión sistemática

Abstract

Background: Rheumatoid arthritis (RA) is a chronic disease characterized by pain, deformity, and functional impairment due to progressive joint damage. This study compares the efficacy and safety of two disease-modifying antirheumatic drugs, leflunomide (LEF) and methotrexate (MTX), through a systematic review. In addition, their clinical characteristics and safety profiles were analyzed to identify effective treatment options that promote treatment adherence and improve patients’ quality of life. Methods: A literature search was conducted in databases such as PubMed, ScienceDirect, SciELO, and the Cochrane Library, selecting studies published between 2016 and 2024. Inclusion criteria included clinical trials and observational studies comparing the efficacy and safety of LEF and MTX in patients with rheumatoid arthritis. Results: The findings support the efficacy and safety of both methotrexate (MTX) and leflunomide (LEF) in the treatment of rheumatoid arthritis. MTX remains the first-line drug, showing better results when a stable dose of 10–25 mg/week is maintained and when combined with prednisone, sulfasalazine, or biologic therapies. The comparative review showed that MTX has better long-term tolerability than LEF. Furthermore, therapeutic combinations such as tocilizumab plus MTX or rituximab plus LEF can optimize the clinical response. In terms of safety, low-dose MTX is associated with hematologic, gastrointestinal, and pulmonary adverse effects, while LEF is associated with a higher risk of infections and other adverse events. Keywords: rheumatoid arthritis, leflunomide, methotrexate