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We thank Dr Anton for pointing out the error which, as previously
explained through personal communication, arose from an error in the
handling of data from the CSM. However, this should not detract from the
main message of our report - that care should be exercised when
prescribing Leflunomide for patients already on Warfarin. As you are
aware, a significant proportion of rheumatoid arthritis patients have
concommitant atherosclerotic disease and are on Warfarin.
The drug point by Lim and Pande (1) contains a large error. They
state that the CSM has received "over 300 reports of raised international
normalised ratio in patients taking leflunomide concurrently with
warfarin". This is a misinterpretation of the data. The CSM has in fact
received over 300 reports of INR increased associated with WARFARIN and
some other drug. There have been 4 reports (on 13th December 2002) of INR
increases associated with leflunomide.
Reference
1. Lim V, Pande I. Leflunomide can potentiate the anticoagulant
effect of warfarin. BMJ 2002; 325: 1333.
Competing interests:
None declared
Competing interests:
No competing interests
07 January 2003
Christopher Anton
Administrative Co-ordinator, West Midlands Centre for Adverse Drug Reaction Reporting
Authors' response to 'Not 300, but 4'
Dear Editor,
We thank Dr Anton for pointing out the error which, as previously
explained through personal communication, arose from an error in the
handling of data from the CSM. However, this should not detract from the
main message of our report - that care should be exercised when
prescribing Leflunomide for patients already on Warfarin. As you are
aware, a significant proportion of rheumatoid arthritis patients have
concommitant atherosclerotic disease and are on Warfarin.
Competing interests:
None declared
Competing interests: No competing interests