product of Mostafa Alaa - college of Midicine - university of Kerbala
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)
3-BIOLOGIC THERAPIES IN RHEUMATOID ARTHRITIS
Anakinra
IL-1 receptor antagonist
Tofacitinib
METABOLISUM by CYP3A4
inhibitor of Janus kinases
Tocilizumab
blocking the IL-6 receptor
Rituximab
B-cell depletion
Abatacept
preventing full T-cell activation
Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab
Infliximab is not indicated for monotherapy
moderate to severe RA, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease
They interfere with the binding of TNF- α to its receptor
IL-1 and TNF- α are pro-inflammatory cytokines involved in the pathogenesis of RA
1-Choice of drug
Most of these agents are contraindicated for use in pregnant women.
For patients with more established disease, use of other biologic therapies is considered
Monotherapy may be initiated with any of the DMARDs
sulfasalazine
hydroxychloroquine
leflunomide
methotrexate
A trial of several different drugs may be necessary
No one DMARD is efficacious and safe in every patient
2-drugs
Glucocorticoids
Sulfasalazine
associated with leukopenia
combination with methotrexate and/or hydroxychloroquine.
early, mild RA
Minocycline
not utilized as first-line therapy
Leflunomideopic
not recommended in patients with liver disease
SE.
hypokalemia and nausea
alopecia
skin rash
a flu-like syndrome
allergic reactions
weight loss
diarrhea
headache
used as monotherapy or in combination with methotrexate
inhibitory action on dihydroorotate dehydrogenase so inhibit DNA
immunomodulatory agent
Hydroxychloroquine
Hydroxychloroquine has less effects on the liver and immune system than other
response 6 weeks to 6 months
unknown mechanisium
Methotrexate
S.E
acute pneumonia-like syndrome
cirrhosis of the liver
mucosal ulceration and nausea
Doses need for RA is less than in cancer
Response 3 to 6 weeks
immunosuppressive and anti-inflammatory effects
Methotrexate is a folic acid antagonist
treatment in patients with rheumatoid or psoriatic arthritis
