| Medications for Scleroderma, Arthritis,
Autoimmune and Rheumatic Diseases |
| This page was written by Janey Willis and has not yet been medically edited. See Disclaimer. |
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| Disease-Modifying Anti_Rheumatic Drugs (DMARDs) |
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| Overview of DMARDs |
| DMARDs are Disease-Modifying Anti-Rheumatic Drugs used for a variety of conditions from Irritable Bowel Disease to scleroderma. DMARDs include immunosuppressants, antimalarial drugs, anti-inflammatory metals, and biologic agents. |
| DMARDs. Provides a list of DMARDs, possible side effects and things to be aware of while taking these mediations. Arthritis.org |
| Immunosuppressants fall under a category of drugs referred to as DMARDs (Disease-Modifying Anti-Rheumatic Drugs). ISN. |
| Scleroderma Treatments and Clinical Trials ISN. |
| Combination Therapy with DMARDS |
| Tolerability of methotrexate (MTX) and leflunomide (LEF) combination therapy for inflammatory arthritis in routine clinical practice: results of a four-centre study. The contrasting modes of action of MTX and LEF make them attractive candidates for use in combination with the potential to provide additive or synergistic actions, perhaps without the need for expensive biologic agents. A. Kaul. Rheumatology Advance Access. July 15, 2008. (Also see: Arthritis and Immunosuppressants) |
| Low-dose Prednisolone in Rheumatoid Arthritis (RA): Adverse Effects (AE) of Various Disease Modifying Antirheumatic Drugs (DMARD). Low-dose glucocorticoids retard radiological progression of RA and exhibit a differential effect on survival of DMARD and degree of AE due to DMARD. J Rheumatol April 15 2008 (Also See: Rheumatoid Arthritis and Medications: steroids) |
| Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. In this large cohort of RA patients, the most heightened risk of serious infections was seen with the use of glucocorticoid agents and immunosuppressive DMARDs. Rheumatology. Volume 46, Number 7 Pp. 1157-1160. (Also see: RA) |
| Therapy with Immunosuppressive Drugs and Biological Agents and Use of Contraception in Patients with Rheumatic Disease. The increasing use of combination therapies containing Methotrexate necessitates ensuring that advice regarding birth control is followed in order to avoid pregnancies exposed to potentially fetotoxic drugs. J Rheumatol 2007 June;34:1266-9. (Also see: Scleroderma and Pregnancy) |
| Biologic Agents |
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| Overview of Biologic Agents |
| Biologics are biologic response modifying agents that block specific pathways and signals of inflammation. Some of the biologics used to treat rheumatic diseases include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), and rituximab (Rituxan). |
| Different biologics block different arm of the immune system. For example, etanercept, infliximab, and adalimumab block tumor necrosis factor (TNF), abatacept blocks an interaction between T cells and macrophages, and rituximab effectively eliminates B cells for several months. |
| Biologics. Biologics technically are a subset of DMARDs. These drugs often work for people in whom other therapies have failed. Arthritis Foundation. |
| Biologic Treatments for Rheumatoid Arthritis. Patient Education. American College of Rheumatology. |
| Biologics: Target specific treatment of systemic and cutaneous autoimmune diseases. Consensus needs be formed to further categorize the clinical profiles of the patients in whom biologics are to be used in the future, given that the long-term safety profiles of these agents are very much unknown at present. Siba P Raychaudhuri. Indian Journal of Dermatology. 3 Jul 2009. (Also see: Autoimmunity) |
| Who Receives Biologics For Treatment Of RA? In multivariable comparisons of biologic users versus a subgroup of patients predominantly managed with steroids, biologic use was associated with younger age, lower baseline pain level, shorter disease duration, and less co-morbidity. Esi Morgan DeWitt. 74/74. ACR 2007. (Also see: RA) |
| Pregnancy Outcome after Exposure to Biologics: Results from the German Biologics Register RABBIT. Even though the numbers of cases are still low and final conclusions cannot be drawn, our data support the current view that exposure to biologic agents until confirmation of pregnancy does not increase the risk for congenital malformations, miscarriages or low birth weight. Anja Strangfeld. 730. ACR 2007. (Also see: Pregnancy) |
| Alemtuzumab (Campath) |
| FDA Alert: Alemtuzumab (marketed as Campath) Information. Three patients in a clinical study of the drug Campath for the treatment of Multiple Sclerosis (MS) developed severe idiopathic thrombocytopenic purpura (ITP). One of the patients died. U.S. Food and Drug Administration. 11/05. |
| Alemtuzumab (Campath): Side Effects. Safety data, except where indicated, are based on 149 patients with B-CLL enrolled in studies of Campath as a single agent administered at a maintenance dose of 30 mg intravenously three times weekly for 4 to 12 weeks. RxList. |
| TNF Inhibitors |
| Tumor Necrosis Factor (TNF) inhibitors include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) |
| Arthritis drugs raise cancer risk in kids-US FDA. The Food and Drug Administration, which urged greater caution with so-called TNF blockers last September, said an analysis of 48 reported cancer cases in children using the drugs "showed an increased risk of cancer, occurring after 30 months of treatment on average." Reuters. 08/04/09. (Also see: FDA Warnings) |
| Clinical Remission in Patients with Systemic Juvenile Idiopathic Arthritis (JIA) Treated with Anti-Tumor Necrosis Factor (TNF) Agents. Twenty-four percent of patients with systemic JIA experienced remission with anti-TNF therapy, but only 13% experienced sustained benefit. Ricardo A.G. Russo. J Rheum. March 30, 2009. (Also see: Juvenile Idiopathic Arthritis) |
| Autoimmune diseases induced by TNF-targeted therapies. The use of anti-TNF agents has been associated with an increasing number of cases of autoimmune diseases, principally cutaneous vasculitis, lupus-like syndrome, systemic lupus erythematosus and interstitial lung disease. (ScienceDirect) Manuel-Ramos Casels, MD. Best Practice & Research Clinical Rheumatology. October 2008. (Also see: Causes of Autoimmunity) |
| Cost-Effectiveness of Abatacept in Patients with Moderately to Severely Active Rheumatoid Arthritis (RA) and Inadequate Response to Tumor Necrosis Factor-α Antagonists (anti-TNF). Abatacept is cost-effective by current standards of medical practice in patients with moderately to severely active RA and inadequate response to an anti-TNF. Montserrat Vera-Llonch. J Rheumatol July 15 2008. (Also see: Rheumatoid Arthritis) |
| FDA Starts Safety Review of Autoimmune Disorder Drugs. Among the chief concerns are whether the drugs are associated with the development of cancer, especially lymphoma, in children and young adults being treated for rheumatoid arthritis or Crohn's disease. Four TNF blockers are currently approved in the United States: Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Cimzia (certolizumab). U.S. News and World Report. 06/04/08. |
| Influenza vaccine response impaired by anti-TNF treatment. Anti-tumor necrosis factor (TNF) alpha treatment modestly impairs the antibody response to influenza vaccination, but allows most patients to achieve a protective titer. The Job Cure (Reuters) 05/21/08. (Also see: Flu and Pneumonia Shots) |
| Exogenous tumor necrosis factor - alpha induces suppression of autoimmune arthritis. The role of endogenous TNF-alpha in the induction and propagation of arthritis is well established. However, exogenous TNF-alpha can downmodulate the course of AA, displaying an immunoregulatory functional attribute of this cytokine. Arthritis Research & Therapy 2008, 10:R38. April 1, 2008. (Also See: Arthritis) |
| Heart failure among younger rheumatoid arthritis (RA) and Crohn's (CD) patients exposed to TNF-{alpha} antagonists. We found only a small number of presumed HF cases in a large population of relatively young RA and CD patients. Rheumatology 2007 46(11):1688-1693. (Also see: RA, and Crohn's Disease) |
| Off-Label Dermatologic Uses of Anti-TNF-a Therapies. Reports suggest that anti-TNF-a therapies may be effective in the treatment of numerous inflammatory skin diseases outside their currently approved indications. PubMed. J Cutan Med Surg. 2006 May 25. (Also see: Causes of Scleroderma: Interleukins, Antibodies and Skin Fibrosis) |
| Tumor necrosis factor inhibition and invasive fungal infections. The use of tumor necrosis factor (TNF) antagonists for the treatment of rheumatoid arthritis and other autoimmune diseases has been associated with an increased incidence of opportunistic infections, including infections with both Candida albicans and Aspergillus fumigatus. PubMed. Clin Infect Dis. 2005 Aug 1;41 Suppl 3:S208-12. |
| Safety of tumour necrosis factor and interleukin-1 blocking agents in rheumatic diseases. Physicians should minimize risks by patient selection and screening for opportunistic infections. PubMed. Autoimmun Rev. 2005 Mar;4(3):162-70. |
| Etanercept (Enbrel) |
| Enbrel. Enbrel (also known by its generic name etanercept) is a biologic medication approved in April 2004 by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe plaque psoriasis and in January 2002 for the treatment of psoriatic arthritis. It is also approved for treating rheumatoid arthritis, juvenile rheumatoid arthritis and ankylosing spondylitis (arthritis affecting the spine). National Psoriasis Foundation. |
| Efficacy and Safety of Etanercept (Enbrel) in the Treatment of Scleroderma-Associated Joint Disease. This case series demonstrates that etanercept appeared to be efficacious in improving active inflammatory joint disease in a subset of scleroderma patients, and it was generally safe and well tolerated. J Rheumatol 2007 July;34:1636. Letter to the Editor. (Also see: Scleroderma Skeletal Involvement) |
| Infliximab (Remicade) |
| Infliximab (Remicade). Patients treated with REMICADE are at increased risk for infections, including progression to serious infections leading to hospitalization or death. RxList. |
| Fertility and Reproduction in Male Patients with Ankylosing Spondylitis (AS) Treated with Infliximab. We identified 4 patients with AS who had fathered 6 healthy children during infliximab treatment. Our cases provide some evidence or reassurance for male patients treated with the anti-tumor necrosis factor-α agent. S. Paschou. J Rheumatol First Release. Dec 1 2008. (Also see: Ankylosing Spondylitis and Male Infertility) |
| An Open-Label Pilot Study Of Infliximab Therapy In Diffuse Cutaneous Systemic Sclerosis (dcSSc). In dcSSc infliximab did not show clear benefit at 26 weeks but was associated with clinical stabilisation and fall in two laboratory markers of collagen synthesis. The frequency of suspected infusion reactions may warrant additional immunosuppression in any future studies in SSc. C. P. Denton. Ann Rheum Dis. 9 September 2008. (Also see: Scleroderma Treatments) |
| Refractory Vertebral Sarcoidosis Responding to Infliximab. We report a case of sarcoidosis, involving the lung and vertebrae, which was refractory to conventional therapy. Our patient's clinical symptoms and radiologic lesions of vertebral sarcoid dramatically improved after treatment with infliximab. Garg, Sanjay MD. Journal of Clinical Rheumatology. August 2008. (Also see: Sarcoidosis) |
| The impact of infliximab (Remicade) treatment on quality of life in patients with inflammatory rheumatic diseases. Patients in large randomized controlled studies of infliximab in Rheumatoid Arthritis, psoriatic arthritis, and ankylosing spondylitis had similar impairment in physical aspects of health-related quality of life (HRQoL) at baseline and showed significantly greater improvement in HRQoL after treatment with infliximab. Arthritis Research & Therapy 2007, 9:R103. (Also see: RA and Psoriasis) |
| Infliximab (Remicade) therapy in pulmonary fibrosis associated with collagen vascular disease. This study suggests that inhibition of TNF-alpha with infliximab may stabilize the progression of pulmonary fibrosis associated with CVD. Prospective, controlled trials are necessary to determine the efficacy of infliximab in pulmonary fibrosis associated CVD. PubMed. Clin Exp Rheumatol. 2007 Jan-Feb;25(1):23-8. (Also see: Pulmonary Fibrosis) |
| Potential off-label use of infliximab in autoimmune and non-autoimmune diseases: a review. The neutralisation of TNF might play a role in the treatment of many autoimmune and non-autoimmune disorders other than Crohn's disease or RA. PubMed. Autoimmun Rev. 2005 Mar;4(3):144-52. |
| Rituximab (Rituxan) |
| Rituxan (Targeted B-cell Therapy). Indications and Uses. FDA Warning. Rituxan.com. |
| REFILE-US rejects wider use of Roche arthritis drug. The Food and Drug Administration does not support approval of Rituxan -- in patients who have not previously received methotrexate or those who did not respond adequately -- due to the rare risk of progressive multifocal leukeoencephalopathy (PML). Reuters (Alibaba.com) 10/19/09. |
| Experience with rituximab (RTX) in scleroderma: results from a 1-year, proof-of-principle study. The results of this small scale study indicate that RTX may improve lung function in patients with SSc. Dimitrios Daoussis Rheumatology. May 15, 2009. |
| Rituximab in diffuse cutaneous systemic sclerosis (dc-SSc): an open-label clinical and histopathological study. Rituximab appears to be well-tolerated and may have potential efficacy for skin disease in dc-SSc. V P Smith. Annals of Rheumatic Diseases. 22 December 2008. (Also See: Clinical Trials) |
| B Cell Reconstitution After Rituximab (Rituxan) Recapitulates B Cell Ontogeny with a Preponderance of Transitional B cells and a Paucity of Memory B Cells. These results suggest fundamental differences in the B cell depletion and/or reconstitution process experienced by different groups of patients that impact clinical and immunologic outcomes. Jennifer H. Anolik. 1974 ACR 2006. (Also see: Causes of Scleroderma: B Cells and T Cells) |
| Antimalarials (Plaquenil, Hydroxychloroquine) |
| Plaquenil (Hydroxychloroquine). Hydroxychloroquine is classified as an anti-malarial drug. It is similar to chloroquine (Aralen) and is useful in treating several forms of malaria as well as lupus erythematosus and rheumatoid arthritis. MedicineNet.com. |
| Systematic review of hydroxychloroquine (Plaquenil) use in pregnant patients with autoimmune diseases. The purpose of this study was to compare the incidence of congenital defects, spontaneous abortions, number of live births, fetal death and pre-maturity in women with autoimmune diseases taking HCQ during pregnancy. It found that HCQ is not associated with any increased risk of congenital defects, spontaneous abortions, fetal death, pre-maturity and decreased numbers of live births in patients with auto-immune diseases. Kirk Sperber Pediatric Rheumatology 13 May 2009. (Also see: Pregnancy and Medications) |
| Medicinal Metals: Gold, Platinum |
| Gold and some other metals have been proven to suppress the inflammatory process. DMARDs such as Auranofin and Gold sodium thiomalate are forms of gold used to treat rheumatic diseases such as rheumatoid arthritis. |
| Gold Preparations (Ridaura, Myochrysine, Solganol). Patient Information. American College of Rheumatology. |
| Mystery solved: Gold's power against autoimmune diseases defined. Gold compounds have been used for the treatment of rheumatoid arthritis and other autoimmune diseases for more than 75 years, but until now, how the metals work has been a mystery. Harvard Medical School researchers report that special forms of gold, platinum, and other classes of medicinal metals work by stripping bacteria and virus particles from the grasp of a key immune system protein. It may now be possible to develop a new generation of gold-based drugs for treating autoimmune diseases that are more effective with fewer side effects. EurekAlert! 02-26-06. |
| Sulfasalazine |
| Sulfasalazine (Azulfidine) is an anti-inflammatory medication that belongs to a class of drugs called sulfa drugs. Sulfasalazine is also known as a disease modifying antirheumatic drug (DMARD) because it not only decreases the pain and swelling of arthritis but also may prevent damage to joints and reduce the risk of long term disability. Patient Information. American College of Rheumatology. |
