Flashcards in Approach to Therapeutics Deck (12)
What approaches are there in the treatment of inflammatory arthritis?
What therapeutic categories are there?
-Non steroidal anti inflammatory drugs (NSAID)
-Disease Modifying anti Rheumatic drugs (DMARD)
-Corticosteroids (oral, i-m, i-a)
What are disease modifying anti rheumatic drugs?
-A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression.
-Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event.
What DMARDs are used in RA?
What DMARDS are not used in RA any more?
What are the general approaches principles for inflammatory joint disease?
-Early and aggressive intervention is the key to obtaining optimal outcomes in the management of RA
-Effective suppression of inflammation will improve symptoms and prevent joint damage and disability
What's so special about methotrexate?
-Effective, well tolerated and cheap
-Cornerstone of combination treatment (with DMARD and biologic)
-People stay on it
What treatment strategies can be used for RA?
-Combination: step up, step down and parallel
Treat to Target
What are biologics?
-Biologic DMARDs have been developed from improved understanding of immunology to target key aspects of inflammatory cascade.
-Typically these are large complex proteins which need to be given parenterally.
-Compared to traditional DMARD, they work rapidly, are generally well tolerated although with important toxicities (eg infection and come at high cost.
Give examples of biologics currently used?
-TNFa inhibitors (x5)
-IL-1 inhibitors (Anakinra)
-Anti B Cell therapies (CD20, Rituximab)
-Anti T Cell therapies (Abatacept)
-IL-6 inhibitors (Tocilizumab)
What issues are there with biologics?
-Efficacy: they have an enhanced response when co prescribed with methotrexate
-Toxicity: minor including injection site reactions to infection and ?malignancy