Safety of Long-Term Use of Four Common Conventional Disease Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis

Abstract

Conventional disease-modifying antirheumatic drugs (DMARDs) have been used in the management of rheumatoid arthritis for a long time. Whereas methotrexate (MTX) is the anchor drug, leflunomide, hydroxychloroquine and sulfasalazine are used along with MTX either in combination or sequentially. Together these four drugs are the most commonly used DMARDs. They are also used in combination with biological DMARDs (bDMARDs) to enhance their efficacy and MTX in particular to reduce antibodies against anti-tumour necrosis factor. Despite their widespread use, concerns regarding their safety especially when used long-term hinder their optimum use in clinical medicine. In this narrative review we have critically appraised the available literature regarding the safety of these four DMARDs when used long-term.

Long‐term outcome of patients with palindromic rheumatism treated with methotrexate

“…9 Cost-effectiveness and efficacy/toxicity of MTX is very good. 10,21 MTX has been used for controlling disease activity and tapering steroid doses in many other rheumatic diseases, including juvenile idiopathic arthritis, systemic lupus erythematosus, Behçet's disease, vasculitis, seronegative spondyloarthritis, idiopathic inflammatory arthritis, and more. 10,21 However, surprisingly, there are few reports ESR and CRP.…”

“…10,21 MTX has been used for controlling disease activity and tapering steroid doses in many other rheumatic diseases, including juvenile idiopathic arthritis, systemic lupus erythematosus, Behçet's disease, vasculitis, seronegative spondyloarthritis, idiopathic inflammatory arthritis, and more. 10,21 However, surprisingly, there are few reports ESR and CRP. 22 Thapa et al reported controlling arthritis attacks with MTX and prednisolone in a 53-year-old man with PR.…”

Safety and efficacy of fecal microbiota transplantation for autoimmune diseases and autoinflammatory diseases: A systematic review and meta-analysis

“…Biologics DMARDs (bDMARDs) are commonly used to treat patients with moderate-to-severe rheumatic disease who do not respond well to or cannot tolerate conventional synthetic DMARDs (12,13). However, none of these drugs or surgical treatments can completely cure autoimmune diseases, only relieve symptoms, they have side effects (severe gastrointestinal adverse reactions and immunosuppression leading to infection), and the price of biological agents is high (14)(15)(16). With the deepening of research, there is evidence that the intestinal microbiota can maintain the body's homeostasis.…”

Comparative efficacy and safety of JAK inhibitors and leflunomide in rheumatoid arthritis: A protocol for systematic review and meta-analysis

“…In recent years, a lot of progress has been made in the development and utilization of disease control drugs for RA, especially biological targeted therapeutic drugs, this has significantly improved the clinical symptoms and disease activity of RA patients. [ 5 – 6 ]…”

“…In recent years, a lot of progress has been made in the development and utilization of disease control drugs for RA, especially biological targeted therapeutic drugs, this has significantly improved the clinical symptoms and disease activity of RA patients. [5][6] Leflunomide (LEF) is one of the most commonly used disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of RA in clinical practice, [7][8] and it was listed as one of the top three recommended treatments for rheumatoid arthritis by the American College of Rheumatology in 2008 [9]. Because its early use can significantly improve the prognosis of patients with RA, LEF has been effectively used for early RA and has been shown to significantly inhibit disease as assessed progression by joint imaging.…”