Disease-modifying agents

VI. CLINICAL TRIALS FOR AD TESTING OF POSSIBLE DISEASE-MODIFYING AGENTS... 

Kremer, 1. M. (2001) Rational use of new and existing disease-modifying agents in rheumatoid arthritis. Annals of Internal Medicine. 134, 695-706. 

Disease-modifying agents currently used in treating rheumatoid arthritis are listed in Table 16-3. As the name implies, DMARDs attempt to induce remission by modifying the pathologic process inherent to rheumatoid arthritis. In general, DMARDs inhibit certain aspects of the immune response thought to... 

The disease-modifying agents used in rheumatoid arthritis are associated with a number of side effects that could influence rehabilitation. Some of these drugs, such as the gold compounds and methotrexate, may cause headache and nausea, which may be bothersome during the therapy session. Joint pain and swelling may also occur with drugs such as methotrexate and peni-... 

Conn DL, Lim SS. New role for an old friend prednisone is a disease-modifying agent in early rheumatoid arthritis. Curr Opin Rheumatol. 2003 15 193-196. 

Clinical Use. Azathioprine (Imuran) is a cytotoxic agent that is structurally and functionally similar to certain anticancer drugs, such as mercaptopurine.22,30 Azathioprine is primarily used to prevent the rejection of transplanted organs, especially in patients with kidney transplants. Azathioprine may also be used to suppress immune responses in a wide range of other conditions, such as systemic lupus erythematosus, dermatomyositis, inflammatory myopathy, hepatic disease, myasthenia gravis, and ulcerative colitis. As presented in Chapter 16, azathioprine is also used as an antiarthritic disease-modifying agent. 

Substances that are able to reduce the requirement for nonsteroidal anti-inflammatory drugs and to slow disease progression are labeled disease-modifying agents. 

The usual therapy includes topical agents that improve moisture and decrease inflammation. Systemic therapy includes steroids and non-steroidal anti-inflammatory agents disease modifying agents and cytotoxic agents to address the extra-glandular aspects of the disorder. 

Analgesics, antipyretics, nonsteroidal antiinflammatory drugs (NSAIDs), drugs used to treat gout and disease-modifying agents used in rheumatic disorders (DMARDs)... 

Disease-modifying agents used in rheumatic disorders... 

Sulfasalazine is also used as a disease-modifying agent in rheumatoid arthritis (see p. 292), the condition for which it was originally introduced in the 1930s. It is available as a tablet, retention enema or suppository. 

O Callaghan JW, Brooks PM. Disease-modifying agents and immunosuppressive drugs iu the elderly. Chu Rheum Dis 1986 2(l) 275-89. 

Proresid (mitopodozide), a mixture of more than 20 derivatives of Podophyllum emodi, has been used for many years in some countries as a disease-modifying agent in rheumatoid arthritis. A microtubuhn antagonist, it is comparable with colchicine and griseofulvin. Its use has been limited because treatment is often comphcated by severe diarrhea, abdominal pain, nausea, and vomiting. Leukopenia and thrombocytopenia have been reported (3,4). 

Tenidap sodium, an antirheumatic drug, combines the clinical and pharmacological properties of NSAIDs with those of a disease-modifying agent. Data from clinical studies have been reviewed (SEDA-19,100). 

Despite encouraging results from well-conducted clinical trials, several relevant issues remain. The most important question in the use of the ABC-R drugs is when to begin therapy. The Medical Advisory Board of the National Multiple Sclerosis Society has adopted recommendations regarding the use of the current MS disease-modifying agents, and these are summarized in Table 53-3. ... 

Second choice—disease-modifying agents Gold salts P-Penicillamine Hydroxychloroquine... 

E. Toxicity All disease-modifying agents can cause severe or fatal toxicities. Careful monitoring of patients who take these dmgs is mandatory. Their major adverse effects are listed in Table 36-1. 

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