Saturday, June 23, 2012


DMARDs is an acronym for disease-modifying antirheumatic drugs. The term has been coined for a category of drugs, which are used to slow down disease progression of rheumatoid arthritis. Later, as these DMARDs were also used in other rheumatic diseases, the term DMARDs was also applied to these diseases.

Biologics (biologicals) is short for biopharmaceuticals and for us in the treatment of rheumatic diseases - such biologics are monoclonal antibodies (MABs) for instance. Biologics belong to the class of DMARDs. Biologics are produced through genetic engineering. These drugs are: abatacept, adalimumab, anakinra (more in use to treat periodic fever syndromes), certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab.

Traditional or conventional DMARDs are “small molecular mass drugs synthesised chemically”. These drugs are: azathioprine, chloroquine and hydroxychloroquine, ciclosporin (better known as cyclosporin A), D-penicillamine (hardly in use anymore because of high rate of adverse events), gold salts (we very seldom still use sodium aurothiomalate), leflunomide, methotrexate (MTX), sulfasalazine (SSZ). Some people include monocycline.
I’ve just read about an article:
BOMBARDIER C, Hazlewood GS, Akhavan P, Schieir O, et al.
Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety.
J Rheumatol. 2012.
I asked myself, which term would be better: traditional or conventional DMARDs?

How will the new small molecules / protein kinase inhibitors like tofacitinib and fostamatinib fit into this terminology? Maybe as PKI DMARDs?

So we might have:
1. conventional or traditional DMARDs
2. biologic DMARDs

Let’s see, where the terminology will lead us to.

A couple of answer!
The following abbreviations are common now:
csDMARD - conventional (like MTX or leflunomide)
tsDMARD - targeted (like apremilast or tofacitinib)
boDMARD - biologic originator (like Remicade)
bsDMARD - biosimilar (like Inflektra)

And a list for three letter abbreviations of DMARDs:
ABA - abatacept
ADA - adalimumab
APR - apremilast
AZA - azathioprine
CyA - cyclosporine A 
ETN - etanercept
GLM - golimumab
IFX - infliximab
LEF - leflunomide
MTX - methotrexate
RTX - rituximab
SSZ - sulfaslazine
SEC - secukinumab
TOC - tocilizumab
UST - ustekinumab

Add further entries via commentary.

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