Disease-modifying antirheumatic drug
(Redirected from DMARD)
A pharmaceutical agent or drug that is categorized by its ability to alter the progression of an autoimmune disease as opposed to just treating the inflammation or symptoms.
Etiology[edit | edit source]
The term disease modifying antirheumatic drug was applied in order to differentiate those drugs that have the potential to slow the progression of the rheumatoid arthritis such as methotrexate, from the symptomatic treatment with NSAIDs that just treat inflammation and steroids that reduce inflammation but do not slow or stop the progression of the disease.
Other diseases[edit | edit source]
Overtime, the DMRD's is also used in other conditions such as Crohn's disease, systemic lupus erythematosus, Sjögren syndrome, immune thrombocytopenic purpura, myasthenia gravis, sarcoidosis, multiple sclerosis etc.
Types[edit | edit source]
- certolizumab pegol
- chloroquine (anti-malarial)
- ciclosporin (Cyclosporin A)
- D-penicillamine (seldom used today)
- gold salts (sodium aurothiomalate, auranofin) (seldom used today)
- [[hydroxychloroquine (anti-malarial)
- methotrexate (MTX)
- sulfasalazine (SSZ)
Types of DMRD's[edit | edit source]
DMRD's can be classified as biologics such as infliximab, ethanercept, abatacept, adalimumab, anakinra, apremilast etc. and synthetic or traditional DMRD's such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, gold salts
DMARDs, their mechanisms of action, JIA approval status, and samples of significant warnings from the drug product labels. | ' | ' | ' | ' |
Generic Name | US Trade Name | Mechanism of Action | Approved by FDA for JIA | Warnings – Increased Risk |
Abatacept | Orencia | anti-CD28, T-cell costimulator antibodies | Yes | infections |
biologic | ||||
Adalimumab | Humira | TNF inhibitor | Yes | infections |
biologic | cancer | |||
Anakinra | Kineret | IL-1 receptor antagonist | No | infections |
biologic | ||||
Canakinumab | Ilaris | IL-1 blocker | No | vertigo |
biologic | ||||
Etanercept | Enbrel | TNF inhibitor | Yes | infections |
biologic | cancer | |||
Infliximab | Remicade | TNF inhibitor | No | infections |
biologic | cancer | |||
IVIG | Baygam | interaction with activating Fc receptors | No | hepatitis |
Carimune NF | biologic | acute renal failure | ||
Flebogamma 5% | venous thrombosis | |||
DIF | aseptic meningitis | |||
Gammar P | ||||
Gamunex 10% | ||||
Gammagard S/D | ||||
Gammagard Liquid 10% | ||||
Gammar P | ||||
Iveegam EN | ||||
Octagam 5% | ||||
Panglobulin | ||||
Polygam S/D | ||||
Privigen 10% | ||||
Vivaglobin | ||||
Rilonacept | Arcalyst | IL-1 blocker | No | infection |
biologic | ||||
Rituximab | Rituxan | binds to CD20 antigen | No | progressive multifocal leukoencephalopathy |
biologic | severe skin reactions | |||
infusion reactions | ||||
Tocilizumab | Actemra | IL-6 receptor antagonist | No | infections |
biologic | elevated lipid levels | |||
Azathioprine | Azasan | purine synthesis inhibitor | No | cancer |
Imuran | nonbiologic | bone marrow suppression | ||
Cyclosporine A | Neoral | inhibits calcineurin | No | infections |
Gengraf | nonbiologic | nephrotoxicity hepatotoxicity | ||
D-Penicillamine | Depen | unknown (may lower IgM rheumatoid factor; depresses T-cell activity) | No | allergic reactions |
Cuprimine | nonbiologic | Goodpasture’s syndrome | ||
hematologic toxicities | ||||
hepatotoxicity | ||||
myasthenia gravis | ||||
Hydroxy-chloroquine | Plaquenil | not well understood (may reduce T-lymphocyte transformation and chemotaxis) | No | kidney damage |
nonbiologic | retinopathy | |||
Leflunomide | Arava | isoxazole immunomodulatory agent | No | hepatotoxicity |
nonbiologic | ||||
Methotrexate | Methotrexate LPF | unknown (antimetabolite; inhibits dihydrofolic acid reductase) | Yes | hepatotoxicity |
nonbiologic | cancer | |||
Mycophenolate mofetil | CellCept | guanosine synthesis inhibitor | No | cancer |
nonbiologic | bone marrow suppression | |||
Sulfasalazine | Azulfidine sulfazine | unknown | Yes | bone marrow suppression |
nonbiologic | hepatotoxicity | |||
Stevens Johnson syndrome | ||||
Tacrolimus (FK506) | Prograf | reduces T-cell and IL-2 activity | No | cancer |
nonbiologic | infection | |||
Thalidomide | Thalomid | unknown | No | birth defects |
nonbiologic | neuropathy | |||
Disease-modifying antirheumatic drug Resources | ||
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Contributors: Prab R. Tumpati, MD