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Dose escalation of leflunomide (LEF) to 40 mg once daily in patients with rheumatoid arthritis and insufficient response to standard dose LEF
  1. C Fiehn,
  2. E Rochel,
  3. A D Ho,
  4. R Max
  1. Department of Internal Medicine V, University of Heidelberg, Germany
  1. Correspondence to:
    Dr C Fiehn
    Centre for Rheumatic Diseases, Baden-Baden, Rotenbachtalstr 5, 76530 Baden-Baden, Germany;

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Leflunomide (LEF) is a new disease modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA) and it is recommended that it is given in a loading dose of 100 mg over 3 days followed by a stable dose of 20 mg/day.1,2 The dose of 20 mg/day LEF was recommended because in an initial study which compared 5, 10, and 25 mg/day LEF the highest dose tended to result in an increased rate of adverse events.3 However, in this study a clear dose-response relationship with best results in the 25 mg/day group was observed as well. Therefore, the aim of this investigation was to evaluate whether patients who tolerate LEF in the standard dose of 20 mg/day will tolerate a dose escalation of LEF to 40 mg/day and whether this …

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