What is the Difference Between Methotrexate and Leflunomide?

Methotrexate and Leflunomide are both drugs used in the treatment of rheumatoid arthritis (RA), but they have some differences in terms of their efficacy, safety, and cost. Here is a comparison of the two drugs:

Efficacy:

Both methotrexate and leflunomide are effective drugs for the long-term treatment of RA.
Some studies suggest that methotrexate provides a slight clinical benefit over leflunomide.
American College of Rheumatology (ACR) 20% response rates and improvement in tender and swollen joints were not significantly different between the two drugs.
Both treatments significantly retarded radiographically assessed progression of RA compared to placebo, but the degree of retardation was significantly greater with leflunomide.

Safety:

Adverse events leading to withdrawal from the study were seen in 19% of the subjects treated with leflunomide and 6% of the subjects treated with methotrexate.
Patients in the leflunomide group were more likely to experience gastrointestinal symptoms and allergic reactions compared to those in the methotrexate group.

Cost:

Methotrexate is a cheaper drug than leflunomide. For example, one month of therapy with leflunomide costs $375 compared with $15 to $31 for methotrexate.

In conclusion, both methotrexate and leflunomide are effective for the treatment of RA, but they have some differences in terms of efficacy, safety, and cost. Methotrexate is generally more cost-effective and has a slightly better safety profile, while leflunomide may provide slightly better clinical outcomes in some cases. The choice between the two drugs should be based on individual patient factors, such as socioeconomic status, tolerability, and response to treatment.