Methotrexate v. Leflunomide

[Francesbarbara]

I have been on Pred (currently at 5mg) plus Methotrexate since May this year. I stopped the Metho two weeks ago to see if it was the medication causing me so much dreadful fatigue. I have felt much better since. Is there anyone who has changed from Metho. to Leflunomide and if so has it been beneficial? Thank you for any observations.

[PMRpro Ambassador]

The former chairperson of the Scottish charity was on mtx and got to a lower dose of pred but couldn't get below 8mg so they decided to try leflunomide. She says she felt it "kick in" and felt better than she had felt for years. I think she got off pred altogether but unfortunately developed peripheral neuropathy and stopped the lef (assumed to be the cause). It had obviously been working well for the PMR as she immediately had a flare. She then tried 10mg as a half dose of lef but it wasn't quite enough and she went back to 15mg which seemed OK. However, I believe she has had a flare and was back to 20mg pred.

It has shown promise in small scale studies - but some patients struggle with adverse effects.

[Francesbarbara in reply to PMRpro]

Thank you for this useful post which I'll keep in mind. I have tel appt with consultant on Tues. so will be interested to hear his suggestions, if any.

[Jackoh in reply to Francesbarbara]

Hi Francesbarbara. I haven’t been on methotrexate but have been on Leflunomide. I believe you have had PMR for about a year? ( I might have miscalculated that!) But certainly not for years. To have reached 5 mg during this time is really good so I wonder why your consultant is suggesting another steroid sparer?

[Francesbarbara in reply to Jackoh]

I have had PMR for 10 months - perhaps a few signs before that but nothing like the pain that hit me in February. I wonder if my consultant is very keen on Metho. as he is Hungarian and I understand that it is very popular choice of drug there. Or perhaps it is my age - I am 79. He started me on both Pred and Metho at the same time which may be unusual?? . His diagnosis is 'Probable seronnegative rheumatoid arthritis with polymyalgic onset and chondrocalcinosis right wrist.'Since commencing and tapering steroids I count myself very lucky to have had no pain whatsoever, just utter fatigue.. Thank you Jackoh, I appreciate your response.