DMARDs and Biologics -- A short comparison

Many of us take DMARDs (Disease Modifying Anti-rheumatic Drugs) and some of us take Biologic Response Modifiers (aka “Biologics”). A lot of us taking Biologics take a DMARD as well. To each, there are upsides and downsides, of course.

The common DMARDs (methotrexate, leflunomide, sulfasalazine and hydroxychloroquine) have long been used in various kinds of inflammatory diseases. They are relatively cheap, seem to be effective for some people, but side effects can be problematic. Their action in Rheumatoid Arthritis is well-known, but not a lot of research has been done on how well they work in Psoriatic Arthritis. Some research suggests that the relief given by DMARDs in PsA may be more a case of relieving symptoms, rather than of preventing joint damage.

Biologics (BRMs – Enbrel, Humira, Simponi, Remicade, etc) are relatively new on the rheumatology and dermatology scene. They are “designer drugs”, engineered to take aim at a single inflammatory substances or its target site in the body. They are very expensive, but side effects are rare. Biologics are proven to change the course of PsA, so they protect your joints from disease damage. As time goes on, a good safety record for these medications is being established. While all medical intervention (even taking an aspirin) involves risk, for most of us, the benefits of these medications greatly outweigh the risks involved.

The inside, detailed story is here –

Gladman, Rosen and Chandran summarize it like this in Chapter 9 of their 2014 reference book on Psoriatic Arthritis –

o There are very few clinical trials conducted with traditional disease modifying anti-rheumatic drugs (DMARDs) in PsA; the evidence to date has not shown significant benefit for joint disease.

o Anti-tumor necrosis factor (TNF) agents are effective in the management of all manifestations of PsA.

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