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Disease-modifying antirheumatic drugs (DMARDs) is a category of drugs used in many autoimmune disorders to slow down disease progression. Their use was first propagated in rheumatoid arthritis (hence their name) but has come to include many other diseases, such as Crohn's disease, lupus erythematosus (SLE), idiopathic thrombocytopenic purpura (ITP), myasthenia gravis and various others.
Some of these drugs are also used in the treatment of ulcerative colitis which may not, strictly speaking, be an autoimmune disorder. (See List of Autoimmune Diseases.)
Some DMARDs are mild chemotherapeutics but use a side-effect of chemotherapy - immunosuppression - as its main therapeutical benefit.
The term was originally introduced to indicate a drug that reduced evidence of processes thought to underly the disease, such as a raised erythrocyte sedimentation rate, reduced haemoglobin level, raised rheumatoid factor level and more recently, raised C-reactive protein level. More recently, the term has been used to indicate a drug that reduces the rate of damage to bone and cartilage. DMARDs can be further subdivided into traditional small molecular mass drugs synthesised chemically and newer 'biological' agents produced through genetic engineering.
Members
| Drug | Mechanism |
|---|---|
| adalimumab | TNF inhibitor |
| azathioprine | Purine synthesis inhibitor |
| chloroquine and hydroxychloroquine (antimalarials) | |
| cyclosporine (Cyclosporin A) | inhibit calcineurin |
| D-penicillamine | Reducing numbers of T-lymphocytes etc. |
| etanercept | TNF inhibitor |
| gold salts (sodium aurothiomalate, auranofin) | |
| infliximab | TNF inhibitor |
| leflunomide | Pyrimidine synthesis inhibitor |
| methotrexate (MTX) | Antifolate |
| minocycline | 5-LO inhibitor |
| sulfasalazine (SSZ) |
Alternatives
When treatment with DMARDs fails, cyclophosphamide or steroid pulse therapy is often used to stabilise uncontrolled autoimmune disease. Some severe autoimmune diseases are being treated with bone marrow transplants in clinical trials, usually after cyclophosphamide therapy has failed.
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- This page was last modified on 24 August 2008, at 08:16.
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