DMARDs  & BIOLOGIC RESPONSE MODIFIERS

   
DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Without treatment, joint inflammation can cause permanent damage. Doctors know that it is wise to prescribe a disease-modifying antirheumatic drug (DMARD) before such damage occurs. People newly diagnosed with an inflammatory form of arthritis, such as RA, may be prescribed a DMARD upon their diagnosis.

Another reason DMARDs should be started early is that, although they are generally effective, they take a long time to show results. For example, hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) may take up to three or four months before effects are noticed. Other drugs, such as methotrexate, work more quickly, but often not quickly enough. For that reason, doctors frequently prescribe an additional drug – such as a corticosteroid or an NSAID – to help control pain and inflammation while the DMARD starts to work.

DMARDs are most commonly used for RA, but some are also used for juvenile RA, ankylosing spondylitis, psoriatic arthritis and lupus. Some, such as chlorambucil (Leukeran), mycophenolate mofetil (CellCept) or cyclosphosphamide (Cytoxan), are used mainly to treat severe organ disease, such as kidney disease caused by lupus or vasculitis. The dosages listed in this chart are for those with RA; your dosage may vary depending on your specific condition and factors like disease severity, age, body weight and other medications you are taking.

Only three DMARDs – auranofin (Ridaura), leflunomide (Arava) and Azulfidine – were actually developed for RA. The others were borrowed from different areas of medicine: Hydroxychloroquine (Plaquenil) is a malaria drug, chlorambucil (Leukeran) and methotrexate are cancer medications and cyclosporine (Neoral) originally was developed to keep the body from rejecting transplanted organs.

Because DMARDs suppress the immune system, always watch for signs of infection – chills, fever, sore throat or cough – and report them to your doctor. And check with your doctor before getting any vaccinations.

Biologics
BIOLOGIC RESPONSE MODIFIERS

The “biologics” (or biologic response modifiers) technically are a subset of DMARDs. Like DMARDs, the biologics stop disease progression; sometimes they initiate a long-lasting remission. Moreover, these drugs often work for people in whom other therapies have failed. In fact, studies show that two-thirds of people with RA respond favorably to a biologic, with most of them achieving remission. In many cases, biologics are used together with standard DMARDs, such as methotrexate.

Unlike DMARDs, which may be used in combination with one another, two biologics are not used together. For instance, abatacept (Orencia), anakinra (Kineret) and rituximab (Rituxan) should not be used with TNF-a inhibitors, and TNF-a inhibitors should not be combined.

Although the biologics work in different ways, all block specific steps in the inflammation process. Adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) block a cytokine called tumor necrosis factor-alpha (TNF-a). Kineret blocks a cytokine called interleukin-1 (IL-1). Abatacept (Orencia) blocks the activation of T cells. Rituximab (Rituxan) blocks B cells.

Like many drugs, biologics have a downside, most often, expense. Also, the drugs must be infused intravenously or injected. Researchers say that future agents may be less expensive and taken orally.