A 49-year-old male asked:
Disclaimer

Alt high 60, AST high 45 on methotrexate 25mg, arava (leflunomide) 20mg, enbrel weekly. Should i be concerned? Never had pblm.

1 doctor answer
Dr. Ronald Krauser
51 years experience in Rheumatology
Maybe: I, personally am not a big fan of using Methotrexate and Arava (leflunomide) in combination because of the increased risk of liver toxicity. Your enzymes are only mildly elevated but i would talk to your rheumatologist about reducing dosages or eliminating one of the meds altogether.
Answered on Jun 28, 2014
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Dr. Tracy Lovell
20 years experience in Rheumatology
agree. if one is still requiring arava plus methotrexate plus a TNF; perhaps a class switch of biologic should occur so that one of the oral DMARDS can be eleiminated
Jul 4, 2013
Dr. Robert Lowe
Dr. Robert Lowe commented
16 years experience in Pediatric Rheumatology
Agree. I have never used Arava at the same time as methotrexate--much more potential for liver toxicity without significant benefit. Particularly since there are a range of excellent biologic agents to choose from (and switch to if one isn't working).
Jul 19, 2013

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