A Review on Comparison of Effectiveness and Safety of Disease Modifying Anti-Rheumatoid Drugs Used in Patients with Rheumatoid Arthritis

Abstract

Objective: To compare the safety and effectiveness of monotherapy as well as combination therapy with disease modifying anti rheumatoid drugs (DMARDs) in rheumatoid arthritis patients. Data sources: Study works limited to the English language and more concentrated to adults by using Google Scholar, PubMed and The Cochrane library. Summary: Some head to head trial works, retrospective studies and prospective cohort studies were used to compare the safety and effectiveness of the therapy. Here we go through the comparison in between each disease modifying anti rheumatoid drug (DMARD) monotherapy, combination with monotherapy and also combination with combination therapy. Conclusion: Among the synthetic DMARDs monotherapy, methotrexate would be the preferred DMARD. Biological DMARDs have more efficacy than synthetic agents and have comparable safety profile. Rituximab would be the preferred agent among the bDMARDs. Since synthetic agents are more economical as compared to biologicals, hence these are preferred over biological agents. Combinations of biological DMARDs with methotrexate have improved efficacy and safety than methotrexate monotherapy. Combination of biological DMARDs have no advantage over biological monotherapy, there was an increased safety risk and no therapeutic benefit. Combination of biological DMARDs with methotrexate have better efficacy than monotherapy with either bDMARDs or methotrexate alone. A triple combination therapy of synthetic DMARDs (methotrexate, sulfasalazine and hydroxychloroquine) had better safety, effectiveness and high tolerability than double combination therapy or monotherapy. Keywords: Rheumatoid arthritis, disease modifying antirheumatoid drugs