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Leflunomide teratogenicity — SCE Rheumatology MCQ

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HardInflammatory ArthritisLeflunomide teratogenicitySCE Rheumatology

A man taking leflunomide for rheumatoid arthritis plans to father a pregnancy. Disease is controlled. What advice is supported by current BSR guidance?

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Correct answer: D — Paternal leflunomide exposure is compatible with conception

Available evidence has not shown harm from paternal leflunomide exposure, and BSR regards it as compatible with conception. This differs from maternal exposure, for which leflunomide is stopped and a cholestyramine washout is used.

Reference: BSR guideline on immunomodulatory antirheumatic drugs in pregnancy and breastfeeding (Published November 2022): https://academic.oup.com/rheumatology/article/62/4/e48/6783012; EULAR recommendations for antirheumatic drugs in reproduction, pregnancy and lactation — 2024 update (Published June 2025): https://doi.org/10.1016/j.ard.2025.02.023