Disease-modifying antirheumatic drug

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

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

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

• abatacept

• adalimumab

• anakinra

• apremilast

• azathioprine

• baricitinib

• certolizumab pegol

• chloroquine (anti-malarial)

• ciclosporin (Cyclosporin A)

• D-penicillamine (seldom used today)

• etanercept

• filgotinib

• golimumab

• gold salts (sodium aurothiomalate, auranofin) (seldom used today)

• [[hydroxychloroquine (anti-malarial)

• infliximab

• leflunomide

• methotrexate (MTX)

• minocycline

• rituximab

• sarilumab

• secukinumab

• sulfasalazine (SSZ)

• tocilizumab

• tofacitinib

• ustekinumab

Types of DMRD's

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

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  Methotrexate skeletal structure

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  Hydroxychloroquine structure

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  Auranofin 2D skeletal structure