Disease-modifying antirheumatic drug

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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]

  • gold salts (sodium aurothiomalate, auranofin) (seldom used today)
  • [[hydroxychloroquine (anti-malarial)

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, Dr.T