From the Guidelines
Disease-modifying antirheumatic drugs (DMARDs) include conventional synthetic DMARDs (csDMARDs) such as hydroxychloroquine, sulfasalazine, methotrexate, and leflunomide, biologic DMARDs (bDMARDs) like TNF inhibitors, IL-6 inhibitors, and T-cell costimulatory inhibitors, and targeted synthetic DMARDs (tsDMARDs) including JAK inhibitors, as outlined in the 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1. The classification of DMARDs is crucial for understanding their application in treating rheumatoid arthritis and other autoimmune conditions. Key points about DMARDs include:
- Conventional synthetic DMARDs (csDMARDs) are often the first line of treatment and include hydroxychloroquine, sulfasalazine, methotrexate, and leflunomide.
- Biologic DMARDs (bDMARDs) are used when csDMARDs are not effective and include TNF inhibitors (etanercept, adalimumab, infliximab), IL-6 inhibitors (tocilizumab), and T-cell costimulatory inhibitors (abatacept).
- Targeted synthetic DMARDs (tsDMARDs) are a newer class and include JAK inhibitors (tofacitinib, baricitinib, upadacitinib). These medications are chosen based on the patient's disease activity level, medical history, and potential contraindications, with the goal of minimizing disease activity and preventing long-term damage, as discussed in the guidelines 1. The choice of DMARD should be made following a shared decision-making process, considering the efficacy, tolerability, and potential side effects of each medication, as well as the patient's preferences and values 1.
From the FDA Drug Label
7.1 Methotrexate Adalimumab has been studied in rheumatoid arthritis patients taking concomitant methotrexate. Although concomitant use of methotrexate and adalimumab resulted in higher response rates compared to adalimumab alone, the overall tolerance and hepatotoxicity profiles were similar
- Disease-Modifying Antirheumatic Drugs (DMARDs) examples include:
- Methotrexate
- Adalimumab (SQ) is also considered a DMARD, specifically a biologic DMARD 2
From the Research
Disease-Modifying Antirheumatic Drugs (DMARDs)
Examples of DMARDs include:
- Methotrexate (MTX) 3, 4, 5, 6, 7
- Sulfasalazine (SASP) 3, 4, 5, 6, 7
- Leflunomide 3, 4, 6
- Hydroxychloroquine 3, 4, 6
- Azathioprine 3
- Cyclosporine 3, 6
- Gold 3
- Aurum 4
- TNF-blockers (e.g. infliximab and etanercept) 4
- Doxycycline 6
- Chloroquine 6
- Intramuscular gold 6
Combination Therapy
Combination therapy with DMARDs, such as methotrexate and sulfasalazine, can be more effective than monotherapy in patients with rheumatoid arthritis 5, 6. Triple DMARD therapy can also be effective 6.