Between Methotrexate and Leflunomide the best 10 difference

Nov 20, 2023
Methotrexate and Leflunomide

Methotrexate is a popular medication used to treat autoimmune conditions and inflammation, with an emphasis on rheumatoid arthritis. Methotrexate and Leflunomide Both drugs are used to treat symptoms and slow down the progression of rheumatoid arthritis.

However, their mechanisms of action and side effects differ. It is important for patients and healthcare professionals to understand the differences between Methotrexate (Leflunomide) and Methotrexate in order to make informed decisions about treatment. This discussion will focus on the unique characteristics of both medications and their clinical applications.

Brief overview of Methotrexate

Methotrexate is a powerful and versatile medicine with many medical applications. It is a member of a drug class known as Disease-modifying Antirheumatic Drugs (DMARDs), and it’s primarily used to treat autoimmune and inflammatory diseases. This is a short overview of Methotrexate.

  1. Classification: Methotrexate can be classified as both an antimetabolite (antimetabolite) and an immunosuppressive agent.
  2. Mechanism It inhibits the activity of a dihydrofolate reductase enzyme, which is responsible for the synthesis of DNA, RNA, and proteins. This disruption of cell division and growth works particularly well against cells that divide rapidly, like those found in the immune system or inflamed tissue.
  3. Indications for Use and Medical Use:
    • Rheumatoid Arthritis: Methotrexate, is a cornerstone of the treatment for rheumatoid arthritis. It reduces joint pain and inflammation in those with this autoimmune disease.
    • Psoriasis: Psoriasis Methotrexate may be prescribed for treating severe cases of psoriasis. This chronic skin condition is characterized by scaly, red plaques.
    • Cancer Treatment: In higher doses of methotrexate, it is used as a chemotherapeutic agent to treat various cancer types, such as leukemia and Lymphoma.
  4. Dosage and Administration: Methotrexate is available orally, as an injection, or subcutaneously.
  5. Common side effects:
    • Gastrointestinal symptoms: Nausea and vomiting can occur.
    • Liver Toxicity: Methotrexate may cause liver function abnormalities.
    • Bone Marrow Suppression: This can cause a drop in the number of blood cells, which increases the risk for infection, anemia, and bleeding.
  6. Monitoring and Precautions:
    • To monitor liver function and cell count, regular blood tests are required.
    • Methotrexate should not be taken during pregnancy because of the possibility of birth defects.
    • Individuals with liver or renal disease should exercise caution.
Figure 01: Methotrexate

Methotrexate is a popular and effective treatment for autoimmune disorders. Its low price and versatility make it an affordable and widely-used option. The potential side effects of this drug and the need to monitor it closely highlight the importance of medical supervision.

A brief overview of Leflunomide

Leflunomide: treats autoimmune and inflammation conditions. It is used to treat rheumatoid and psoriatic diseases. Leflunomide is briefly described below:

  1. Classification: Leflunomide has been classified as an immunosuppressive and disease-modifying antirheumatic (DMARD) drug.
  2. Mechanism: Leflunomide exerts therapeutic effects by blocking the activity of a dihydroorotate-dehydrogenase enzyme, which is responsible for the production of DNA in rapidly dividing cells. Leflunomide inhibits the abnormal immune responses seen in autoimmune diseases by interfering with those processes.
  3. Indications for Use and Medical Use:
    • Rheumatoid Arthritis: Leflunomide can be prescribed to treat the symptoms of rheumatoid arthritis, such as joint pain, swelling, and damage.
    • Psoriatic Arthritis: It can also be used to treat Psoriatic arthritis, an autoimmune disease that affects the skin as well as joints.
  4. Dosage and Administration: Leflunomide tablets are usually administered orally. The dosage can vary depending on a patient’s health and their response to treatment.
  5. Common side effects:
    • Diarrhea: Leflunomide can cause gastrointestinal symptoms including diarrhea.
    • Elevated liver enzymes: may cause abnormal liver function tests.
    • Hypertension: Certain patients may experience an increase in blood pressure.
  6. Monitoring and Precautions :
    • To monitor liver abnormalities, it is essential to perform regular liver function tests.
    • Leflunomide should not be used during pregnancy because of the potential for birth defects. It may be necessary to perform a specific washout procedure in order to remove the drug from your body before you attempt pregnancy.
Figure 02: Leflunomide

Leflunomide has been shown to be effective in treating autoimmune arthritis. Methotrexate is another common DMARD. These medications are often chosen by physicians based on the characteristics of the patient and their individual factors. To maximize the benefits of immunosuppressive therapies and to minimize their risks, it is important that they are closely monitored by a medical professional.

Methotrexate and Leflunomide in the comparison chart

Here’s a comparison chart highlighting the key differences and similarities between Methotrexate and Leflunomide:

Aspect Methotrexate Leflunomide
Classification DMARD (Disease-Modifying Antirheumatic Drug), Immunosuppressive DMARD (Disease-Modifying Antirheumatic Drug), Immunosuppressive
Mechanism of Action Inhibits dihydrofolate reductase enzyme, affecting DNA, RNA, and protein synthesis Inhibits dihydroorotate dehydrogenase, affecting DNA and RNA synthesis
Indications and Medical Uses – Rheumatoid arthritis – Psoriasis – Cancer treatment – Rheumatoid arthritis – Psoriatic arthritis
Dosage and Administration Oral, injection, or subcutaneous injection, dosage varies by condition For oral tablets, the dosage varies by condition
Common Side Effects – Gastrointestinal symptoms (nausea, vomiting, diarrhea) – Liver toxicity – Bone marrow suppression – Diarrhea – Elevated liver enzymes – Hypertension
Monitoring and Precautions – Regular blood tests (liver function and blood cell counts) – Contraindicated in pregnancy – Caution in liver or kidney disease – Regular liver function tests – Contraindicated in pregnancy – Caution in liver or kidney disease
Comparative Effectiveness in RA Both are effective DMARDs; choice depends on patient factors and disease characteristics Both are effective DMARDs; choice depends on patient factors and disease characteristics
Cost Considerations Methotrexate is often less expensive Leflunomide can be more expensive
Availability Widely available and often considered a first-line therapy Available but may be considered after Methotrexate or in combination
Drug Interaction Potential Both can interact with other medications; careful monitoring is necessary Both can interact with other medications; careful monitoring is necessary

The choice between Methotrexate or Leflunomide is based on the individual patient’s factors, the severity of the disease, and the presence of comorbidities. These factors are carefully evaluated by healthcare providers to determine which treatment is best for each patient. In addition, research and development in the field of arthritis rheumatoid may affect treatment decisions.

Importance of understanding the differences between these medications

It is important to understand the differences between Leflunomide and Methotrexate for several reasons:

  1. Optimizing treatment efficacy: By understanding the differences between these drugs, healthcare providers can make an informed decision about which medication is best for a particular patient. Treatments can be tailored to the individual’s specific needs and characteristics of their disease. This will lead to better results.
  2. Minimizing side effects: Each medication has a unique set of possible side effects and safety concerns. Understanding these differences allows healthcare providers to select the drug that is least likely to have adverse effects on a patient. This improves their quality of life.
  3. Managing Comorbidities: Patients with autoimmune diseases like rheumatoid arthritis often have other medical conditions. Knowing the differences between medications allows healthcare providers to select the medication that will have the least impact on comorbidities.
  4. Pregnancy Considerations: Both Methotrexate (Leflunomide) and Leflunomide are associated with significant risks during pregnancy. Women of childbearing years must be aware of these risks so that healthcare providers can use appropriate contraception strategies, discontinue medications, or eliminate drugs when planning a pregnancy.
  5. Patient education: Patients who are well-informed can take an active role in making treatment decisions. Patients who understand the differences between Methotrexate (as well as Leflunomide) and Leflunomide can communicate better with their healthcare providers. They can ask questions and make decisions that are in line with their values and preferences.
  6. Cost considerations: The cost of a medication can play a major role in the decision to purchase it. Understanding the cost differences between Methotrexate vs. Leflunomide will help both patients and healthcare professionals make informed decisions.
  7. Avoiding drug interactions: Both drugs can interact with each other. Understanding drug interactions is important to avoid potential complications for patients who take multiple medications.
  8. Keep up to date with new developments: Medical research is progressing, and there may be new treatments and medications. Understanding the differences between Methotrexate (methotrexate) and Leflunomide will help healthcare providers and patients evaluate and adopt new treatments as they become available.
  9. Adherence to Treatment: When patients know why and how a medication is prescribed for them, they will be more likely to stick to their treatment plan. This is important for treating chronic conditions such as rheumatoid arthritis.
  10. Improved Life Quality: The correct medication choice can ultimately lead to better symptom control, disease management, and improved quality of life. Understanding the differences between Methotrexate (methotrexate) and Leflunomide can help you achieve these positive outcomes.

Understanding the differences among these medications is crucial for optimizing treatment, minimizing risk, and ensuring patients receive the best care possible for their autoimmune and inflammatory conditions. Both healthcare providers and patients can make informed decisions about the treatment options.

Considerations for Choosing Between Methotrexate and Leflunomide

Consider several factors when choosing between Methotrexate or Leflunomide to treat conditions such as rheumatoid and psoriatic arthritis.

Consider these key factors when choosing between the two medications:

  1. The Disease Characteristics:
    • Type & Severity: Consider the type and severity of the autoimmune disease you are treating. Choose a different treatment for rheumatoid or psoriatic arthritic conditions.
    • Disease activity: Determine the severity of the disease. Methotrexate is sometimes preferred because it has a faster onset, while Leflunomide can be used for milder, less active diseases.
  2. Patient Factors:
    • Individual health profile: Consider the patient’s general health, including any comorbidities or other medical conditions. Also, consider possible contraindications for either medication.
    • Fertility and Pregnancy: For women who are of childbearing years, the possibility of an unintended pregnancy or pregnancy plans must be taken into consideration. Methotrexate should be avoided during pregnancy. Leflunomide is also dangerous.
  3. Previous Treatment Response:
    • If applicable, evaluate the patient’s reaction to previous treatments. Consider alternative options if a medication was tried previously and failed to produce the desired results.
  4. Drug tolerance and allergies:
    • Consider the patient’s past history of medication tolerance and allergies. This can help determine which drug will be tolerated better.
  5. Cost and accessibility:
    • Methotrexate can be less expensive than Leflunomide, so consider the patient’s financial status and insurance coverage. The availability of either medication can also vary depending on location.
  6. Potential Drug Interactions:
    • Examine the current medication of the patient and any potential drug interactions. Methotrexate can interact with Leflunomide, and vice versa. It’s therefore important to check the patient’s current medication regimen.
  7. Monitoring and Safety:
    • Both medications require regular blood tests and safety evaluations.
  8. Patient Preferences:
    • Include the patient in decision-making, taking into account their lifestyle, preferences, and comfort level with the medication chosen. Engagement of the patient and adherence to their treatment is crucial for success in the long term.
  9. Long-Term Goals:
    • Discuss with the patient their long-term treatment goals. Some people may want a medication to provide quick symptom relief while others might prioritize slowing the disease progression.
  10. Physician Expertise:
    • The prescribing doctor’s familiarity with the medication and his/her experience may have an impact on the decision.
  11. Combination Therapy:
    • For enhanced therapeutic effects, it may be possible to combine Methotrexate with Leflunomide and other DMARDs. This is a common approach in cases of moderate to severe rheumatoid arthritis.

The final decision between Methotrexate or Leflunomide is best made in collaboration between the patient and the healthcare provider. All relevant factors should be considered. To make an informed choice, it is important to assess the patient’s individual circumstances, including their clinical status and preferences.


Methotrexate or Leflunomide is the best choice for treating autoimmune and inflammation conditions such as psoriatic and rheumatoid. This decision should be made based on factors specific to each patient, their disease characteristics, and safety concerns.

It is important that healthcare providers and patients work closely together to determine the best medication to match the patient’s goals and needs. This will lead to a more effective treatment.