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Leflunomide Dosing — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyLeflunomide DosingSCE Rheumatology

A 52-year-old woman with RA is being started on Leflunomide. According to BSR 2025 csDMARD guidelines, what is the recommended approach to loading and maintenance dosing?

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Correct answer: C — No loading dose; start at 20 mg daily

BSR 2025 csDMARD guidelines recommend starting Leflunomide at 20 mg daily without a loading dose. The previous practice of using a 100 mg loading dose for 3 days is no longer recommended due to increased risk of adverse effects (particularly GI toxicity and hepatotoxicity) without significant clinical benefit in achieving faster onset of action. If 20 mg is not tolerated, the dose can be reduced to 10 mg daily.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions