DMARDs are disease-modifying anti-rheumatic drugs used to treat autoimmune conditions such as rheumatoid arthritis. Here, we review DMARDs pharmacology – the primary members, how they work, and what other, more specific indications they are used to treat.
Even though DMARDs share a common indication – rheumatoid arthritis – individual DMARDs are used to treat a variety of other inflammatory and auto-immune diseases.
The purpose of DMARDs is to slow the progression of rheumatoid arthritis. In contrast, NSAIDs (non-steroidal anti-inflammatory drugs) are used to treat symptoms of these conditions – such as inflammation – but do not seek to address any underlying cause.
DMARDs are used to address these cause and therefore slow disease progression. DMARDs also differ from steroid drugs. Whereas steroids dampen the immune response, DMARDs address the underlying cause.
Before we learn more about how to choose the right DMARD and how specific drugs achieve their therapeutic effects, let’s first learn about DMARDs classification and what indications they are used to treat.
DMARDs are classified as:
Synthetic DMARDs are traditional, small molecular mass drugs in contrast to the heavier molecular mass biologic agents.
Due to their mechanism of action, DMARDs are effective in the treatment of other inflammatory-autoimmune states. Examples include:
The function of DMARDs is to:
However, treating autoimmune conditions such as these can take many weeks/months to take effect. The precise time depends on the drug, the patient, their condition or any underlying conditions, and disease progression to date.
Typical treatment regimens include:
DMARDs are not administered to provide immediate symptomatic relief. Other drugs, such as NSAIDs or analgesics, are instead given for this purpose. For this reason, DMARDs are sometimes referred to as “remission inducing drugs”.
When choosing a DMARD, there are a variety of factors to consider.
These are not the only clinical factors to consider, but they place into focus how and why one DMARD may be chosen over another.
Here, you can learn more about how specific DMARDs achieve their therapeutic effects. The mechanism of action of DMARDs varies considerably, as tabled here:
|DMARD||Mechanism of Action|
|Methotrexate||Purine metabolism inhibitor|
|Hydroxychloroquine||Induces apoptosis of inflammatory cells; decreases chemotaxis; targets TNF-alpha|
|Leflunomide||Pyrimidine synthesis inhibitor via inhibition of the enzyme dihydroorotate dehydrogenase|
|Chloroquine||Suppression of IL-1; apoptosis of inflammatory cells|
|Azathioprine||Purine synthesis inhibitor|
|Anakinra||Antagonist of IL-1|
|Abatacept||Binds to CD80 and CD86, preventing T-cell activation|
|Rituximab||Acts against CD20 protein on B-cell surface, triggering cell death|
|Sulfasalazine||Suppression of IL-1 and TNF-alpha|
|Tocilizumab||IL-6 receptor antagonist|
|Tofacitinib||Inhibitor of the kinases JAK1 and JAK3, which transmit extracellular data to the cell nucleus – influencing DNA transcription|
|Certolizumab pegol||TNF inhibitor|
That concludes our review of DMARDs pharmacology. Check back to our pharmacy blog soon for more exclusive content to help you master the science behind drugs and medicines.