Leflunomide link to interstitial lung disease

Patients taking leflunomide, methotrexate or a combination of these should be monitored closely and informed about the possible early warning signs of toxicity, including interstitial lung disease, the latest ADRAC bulletin advises. Reports of ILD with leflunomide alone or in combination with methotrexate (also unilaterally associated with ILD) have been described in two previous bulletins. Between December 2006 and June 2009 the Australian Adverse Drug Reactions Committee received 845 reports of suspected adverse reactions with leflunomide, 196 of which described respiratory symptoms including 39 of ILD. Of these reports, 153 (78%) described concomitant use of methotrexate and 23 of the 39 ILD reports involved this combination. Although clinically variable, manifestations of drug-induced pulmonary toxicity commonly included fever, cough, dyspnoea, pleurisy, chest pain, hypoxaemia and/or radiological evidence of pulmonary infiltrates, the bulletin said. New onset or worsening pulmonary symptoms with or without associated fever in those taking leflunomide with or without methotrexate may indicate development of leflunomide lung and should prompt further investigation, the bulletin advised. If ILD develops, discontinuation of these therapies and implementation of a washout with cholestyramine (as recommended in the leflunomide Product Information) may be appropriate, it concluded....