hydroxychloroquine + leflunomide + methotrexate + prednisolone

This is a combination therapy consisting of four drugs commonly used in the management of autoimmune and inflammatory diseases, particularly rheumatoid arthritis. The regimen includes three conventional disease-modifying antirheumatic drugs (DMARDs)—hydroxychloroquine, leflunomide, and methotrexate—along with prednisolone, a corticosteroid. - **Hydroxychloroquine** is an antimalarial agent that also modulates immune activity by interfering with lysosomal activity and antigen presentation in immune cells. - **Leflunomide** inhibits dihydroorotate dehydrogenase, blocking de novo pyrimidine synthesis required for lymphocyte proliferation[1]. - **Methotrexate** acts as an antifolate agent inhibiting dihydrofolate reductase and other enzymes involved in purine metabolism, leading to immunosuppression[1][2]. - **Prednisolone** is a synthetic glucocorticoid that suppresses inflammation by binding to the glucocorticoid receptor and altering gene transcription. This combination targets multiple pathways involved in autoimmunity and inflammation to reduce symptoms, prevent joint damage, and induce remission in conditions like rheumatoid arthritis. Combination regimens are often used when monotherapy does not achieve adequate disease control or when rapid symptom relief is needed[2][6][7].