RA101: Treatments for RA

The goal of treating rheumatoid arthritis (RA) is to bring symptoms under control and slow its progression.1,2

Treatments for RA are called disease modifying anti-rheumatic drugs (DMARDs). As of the last update, 13 DMARDs are on the market. A majority of DMARDs are indicated for moderate-to-severe RA.1

Treatments for RA

Class of treatment Drugs (generic name)
Conventional DMARD1 Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine
Biologic DMARD1 Humira (adalimumab)
Cimzia (certolizumab pegol)
Enbrel (etanercept)
Simponi (golimumab)
Remicade (infliximab)
Rituxan (rituximab)
Orencia (abatacept)
Actemra (tocilizumab)
Targeted DMARD1 Xeljanz (tofacitinib)
 
 

Based on guidelines:3

  • The first treatment for RA is usually a conventional DMARD, such as methotrexate.
  • Once symptoms worsen, the dose of the conventional DMARD may be increased.
  • If the condition progresses to moderate-to-severe RA, a biologic or targeted DMARD may be added onto methotrexate.
  • Methotrexate may not be right for all patients with RA. Certain biologic or targeted DMARDs may be given without methotrexate in some cases.

Biologic DMARDs may sometimes be called biologics for short. They are the most widely used treatments for moderate-to-severe RA, and can cost upwards of $40,000 per patient per year.

As their patents expire, generic versions of biologics are starting to emerge, called ‘bio-similars’. In theory, they should be just as good as the original biologics, with perhaps discounts of 30-40%.

Targeted DMARDs are a relatively new class of treatment. They are usually pills marketed as alternatives to biologics. However, despite being pills rather than injections, targeted DMARDs may cost just as much as biologics, if not more.1-3

To learn more:

What to expect?

Managing side effects

References: 1. Smolen JS, et al. Lancet 2016. Published online: May 3, 2016. 2. UpToDate. Patients information: Rheumatoid arthritis treatment (beyond the basics). Available at http://www.uptodate.com. Accessed on May 05, 2016. 3. Singh JA, et al. Arthritis Care Res 2015;68(1):1-25.

Last updated: September 17, 2016.
Photo adapted from original by DarkoStojanovic, used under license.

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