Disease Modifying Antirheumatic Drugs

DISEASE MODIFYING ANTIRHEUMATIC DRUGS

Rheumatoid arthritis is an immunologic disease that causes significant systemic effects, shortens life, and reduces mobility and quality of life. Interest has centered on finding treatments that might arrest—or at least slow—this progression by modifying the disease itself. The effects of disease-modifying therapies may take 6 weeks to 6 months to become clinically evident, although some biologics are effective within 2 weeks or less.

These therapies include nonbiologic disease-modifying antirheumatic drugs (usually designated “DMARDs”) such as methotrexate, azathioprine, chloroquine and hydroxychloro-quine, cyclophosphamide, cyclosporine, leflunomide, mycophe-nolate mofetil, and sulfasalazine. Gold salts, which were once extensively used, are no longer recommended because of their significant toxicities and questionable efficacy.

There are also several biologic DMARDs (designated “biologics”) marketed for rheumatoid arthritis: a T-cell-modulating biologic (abatacept), a B-cell cytotoxic agent (rituximab), an anti-IL-6 receptor antibody (tocilizumab), and the TNF-α-blocking agents (five drugs).

These DMARDs and biologics are discussed alphabetically, independent of origin.