Mechanism based pharmacodynamic interactions of glucocorticoids and DMARDs- A review

Abstract

Combination of conventional disease-modifying antirheumatic drugs (cDMARDs), which assist in achieving effective disease control and functional outcomes in rheumatoid arthritis (RA), is widely accepted as an effective treatment regimen. Steroid is often used in combination with DMARDs and there are several uncertainties associated with the regimen, including the therapeutic benefits of the combination. Further understanding the pharmacodynamics and mechanism of actions of steroids and possible drug interactions may assist in improving the treatment outcomes. While the treatment has shown to be effective with better outcome, the use of steroids in the combination regime has been a topic of contradiction.The pharmacodynamic actions of corticosteroids and cDMARDs is variable and overlapping in some domains. In a highly dynamic and constantly adopting immune system, the expression of receptors and signal pathways depends on various factors including the status of cytokine and antigen load. The pattern of introduction of the drugs is one of the major challenges that hampers the effective use of synergism and other interactions associated with the combination. Understanding the drug mechanism and interaction pathways and their variability is essential for customizing the treatment strategies. This review article addresses the current trends of combined treatment in the management of RA. It is also aimed at providing consolidated information on the pharmacodynamic interactions of glucocorticoids and DMARDs in RA.