Disease modifying anti-rheumatic drugs

Disease-modifying Anti-rheumatic Drugs (DMARDs)... 

Unfortunately, a substantial proportion of patients with autoimmune inflammatory diseases have become refractory to NSAIDs, and/or oral or intravenous Disease Modifying Anti Rheumatic Drugs (DMARDs). However, oral combinations of DMARDs generate better outcomes compared to single drug therapy in autoimmune disease. Even autoimmune diseases can become refractory to oral DMARD combinations. 

Garrood T, Scott DL. Combination therapy with disease modifying anti-rheumatic drugs in rheumatoid arthritis. BioDrugs. 2001 15 543-561. 

M.J.M. Wijnands, and P.L.C.M. Van Riel, Management of adverse effects of disease modifying anti-rheumatic drugs. Drugs Saftey 13 219-227, 1995. 

DMARD = disease modifying anti-rheumatic drug. 

In eight children with juvenile rheumatoid arthritis, who had failed to respond to disease-modifying anti-rheumatic drugs, high-dose etanercept was well tolerated (35). None withdrew because of etanercept-related adverse events. One child reported transient erythema at the injection site after the first injection. Three had mild transient upper respiratory tract infections. There were no laboratory abnormalities. 

Leflunomide has anti-inflammatory, immunosuppressive, and virustatic effects. Its efficacy has been demonstrated in patients with rheumatoid arthritis and psoriatic arthritis and other conditions in randomized, double-blind, placebo-controlled trials and other studies (8-32), and it was approved for treatment of adult rheumatoid arthritis in August 1998 (Table 1) (33). In three large phase III trials (US301, n = 482 MN301, n = 358 MN302, n = 999), leflunomide was as effective and well tolerated as methotrexate and sulfasalazine and superior to placebo (34). These data were confirmed by a meta-analysis (35,36). Leflunomide is therefore indicated for patients with rheumatoid arthritis who have failed first-line disease modifying anti-rheumatic drug therapy on the basis of efficacy, safety, and costs (36). It is effective as monotherapy and in combination with methotrexate or infliximab (6). 

Scott DL. Interstitial lung disease and disease modifying anti-rheumatic drugs. Lancet 2004 363(9416) 1239 0. 

Kale VP, Bichile LS. Leflunomide a novel disease modifying anti-rheumatic drug. J Postgrad Med 2004 50(2) 154-7. 

Dijkmans BA, de Vries E, de Vreede TM. Synergistic and additive effects of disease modifying anti-rheumatic drugs combined with chloroquine on the mitogen-driven stimulation of mononuclear cells. Clin Exp Rheumatol 1990 8(5) 455-9. 

Grove ML, Hassell AB, Hay EM, Shadforth MF. Adverse reactions to disease-modifying anti-rheumatic drugs in clinical practice. QJM 2001 94(6) 309-19. 

Disease-modifying anti-rheumatic drugs (DEMARDs) are usually necessary to reduce the inflammation around the joints and inhibit the progression of rheumatoid arthritis. 

FIGURE 89-4. Algorithm for treatment of rheumatoid arthritis. RA, rheumatoid arthritis NSAID, nonsteroidal anti-inflammatory drugs Rx, therapy DMARD, disease-modifying anti rheumatic drug. 

Chloroquine - antimalarial, disease-modifying anti-rheumatic drug... 

Hydroxychloroquine - antimalarial, disease-modifying anti-rheumatic drug Hydroxycobolamin - Vitamin replacement Hydroxyurea - chemotherapy of cancers... 

Synthetic Disease-Modifying Anti rheumatic Drugs... 

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