leflunomide + methotrexate + prednisone

This is a combination therapy consisting of three drugs—leflunomide, methotrexate, and prednisone—used primarily in the management of rheumatoid arthritis (RA). Leflunomide and methotrexate are both disease-modifying antirheumatic drugs (DMARDs) with distinct mechanisms; leflunomide inhibits de novo pyrimidine synthesis via dihydroorotate dehydrogenase inhibition, while methotrexate inhibits purine metabolism as an anti-metabolite. Prednisone is a synthetic glucocorticoid corticosteroid that acts as an anti-inflammatory and immunosuppressant. This combination aims to provide additive or synergistic effects for patients with active RA who do not respond adequately to monotherapy. The regimen can improve clinical outcomes but requires careful monitoring due to increased risks of hepatotoxicity, immunosuppression, and infection[1][2][4][5].