Advertisement

Disease-Modifying Anti-Rheumatic Drugs

  • Ian C. Scott
  • James B. Galloway
  • David L. Scott
Chapter

Abstract

DMARDs are a diverse range of drugs. They form a single group because they both improve symptoms and modify the course of the disease. They form the cornerstone of inflammatory arthritis management. A range of DMARDs exist. Methotrexate is most commonly used in clinical practice, followed by sulfasalazine and hydroxychloroquine. All DMARDs have potential adverse events and require monitoring, often with blood tests. Historically patients were treated with a single DMARD at a time (termed DMARD monotherapy). There has been a recent shift towards starting more than one DMARD at the same time (termed DMARD combination therapy) in patients with RA. This chapter will provide an overview of the different available DMARDs, their mechanisms of action, risks and benefits alongside the evidence base supporting their use.

Keywords

DMARD Methotrexate Sulfasalazine Hydroxychloroquine Efficacy Side-Effects 

References

  1. 1.
    Gaujoux-Viala C, Nam J, Ramiro S, Landewe R, Buch MH, Smolen JS, et al. Efficacy of conventional synthetic disease-modifying antirheumatic drugs, glucocorticoids and tofacitinib: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2014;73:510–5.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    van Gestel AM, Haagsma CJ, Furst DE, van Riel PL. Treatment of early rheumatoid arthritis patients with slow-acting anti-rheumatic drugs (SAARDs). Baillieres Clin Rheumatol. 1997;11:65–82.PubMedCrossRefGoogle Scholar
  3. 3.
    Donahue KE, Gartlehner G, Jonas DE, Lux LJ, Thieda P, Jonas BL, et al. Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med. 2008;148:124–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Chakravarty K, McDonald H, Pullar T, Taggart A, Chalmers R, Oliver S, et al. BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists. Rheumatology (Oxford). 2008;47:924–5.CrossRefGoogle Scholar
  5. 5.
    O’Mahony R, Richards A, Deighton C, Scott D. Withdrawal of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2010;69:1823–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Agarwal S, Zaman T, Handa R. Retention rates of disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. Singapore Med J. 2009;50:686–92.PubMedGoogle Scholar
  7. 7.
    Solomon DH, Bitton A, Katz JN, Radner H, Brown EM, Fraenkel L. Review: treat to target in rheumatoid arthritis: fact, fiction, or hypothesis? Arthritis Rheum. 2014;66:775–82.CrossRefGoogle Scholar
  8. 8.
    Huynh D, Kavanaugh A. Psoriatic arthritis: current therapy and future approaches. Rheumatology (Oxford). 2015;54:20–8.Google Scholar
  9. 9.
    Yang Z, Zhao W, Liu W, Lv Q, Dong X. Efficacy evaluation of methotrexate in the treatment of ankylosing spondylitis using meta-analysis. Int J Clin Pharmacol Ther. 2014;52:346–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Smolen JS, Kalden JR, Scott DL, Rozman B, Kvien TK, Larsen A, et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group. Lancet. 1999;353:259–66.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen S, Cannon GW, Schiff M, Weaver A, Fox R, Olsen N, et al. Two-year, blinded, randomized, controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate. Utilization of Leflunomide in the Treatment of Rheumatoid Arthritis Trial Investigator Group. Arthritis Rheum. 2001;44:1984–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Strand V, Cohen S, Schiff M, Weaver A, Fleischmann R, Cannon G, et al. Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Leflunomide Rheumatoid Arthritis Investigators Group. Arch Intern Med. 1999;159:2542–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Scott DL, Strand V. The effects of disease-modifying anti-rheumatic drugs on the Health Assessment Questionnaire score. Lessons from the leflunomide clinical trials database. Rheumatology (Oxford). 2002;41:899–909.CrossRefGoogle Scholar
  14. 14.
    Jones G, Halbert J, Crotty M, Shanahan EM, Batterham M, Ahern M. The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials. Rheumatology (Oxford). 2003;42:6–13.CrossRefGoogle Scholar
  15. 15.
    Favalli EG, Biggioggero M, Meroni PL. Methotrexate for the treatment of rheumatoid arthritis in the biologic era: still an “anchor” drug? Autoimmun Rev. 2014;13:1102–8.Google Scholar
  16. 16.
    Braun J, Kastner P, Flaxenberg P, Wahrisch J, Hanke P, Demary W, et al. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: results of a six-month, multicenter, randomized, double-blind, controlled, phase IV trial. Arthritis Rheum. 2008;58:73–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Pincus T, Castrejon I. Evidence that the strategy is more important than the agent to treat rheumatoid arthritis. Data from clinical trials of combinations of non-biologic DMARDs, with protocol-driven intensification of therapy for tight control or treat-to-target. Bull Hosp Jt Dis. 2013;71 Suppl 1:S33–40.Google Scholar
  18. 18.
    Bijlsma JW. Disease control with glucocorticoid therapy in rheumatoid arthritis. Rheumatology (Oxford). 2012;51 Suppl 4:iv9–13.Google Scholar
  19. 19.
    Ma MH, Kingsley GH, Scott DL. A systematic comparison of combination DMARD therapy and tumour necrosis inhibitor therapy with methotrexate in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2010;49:91–8.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Ian C. Scott
    • 1
  • James B. Galloway
    • 2
  • David L. Scott
    • 2
  1. 1.Molecular and Cellular Biology of InflammationKing’s College LondonLondonUK
  2. 2.RheumatologyKing’s College HospitalLondonUK

Personalised recommendations