INFO - The ACR 2008 recommendations for nonbiologic and biologic DMARD use in RA

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The ACR 2008 recommendations for nonbiologic and biologic DMARD use in

RA include:

Initiating methotrexate or leflunomide therapy was recommended for

most RA patients.

Methotrexate plus hydroxychloroquine was endorsed for patients with

moderate to high disease activity.

The triple DMARD combination of methotrexate plus hydroxychloroquine

plus sulfasalazine for patients with poor prognostic features and

moderate to high levels of disease activity.

Prescribing anti-TNF¦Á agents¡½etanercept, infliximab, or

adalimumab¡½along with methotrexate in early RA (less than 3 months)

only for patients with high disease activity who had never received

DMARDs. In intermediate- and longer-duration RA, anti-TNF¦Á agents were

recommended for patients who had failed to respond adequately to

methotrexate therapy.

Reserving the fusion protein abatacept and the B-cell

antibody(rituximab) for patients with at least moderate disease

activity and poor disease prognosis for whom methotrexate in

combination with or sequential administration of other nonbiologic

DMARDs led to an inadequate response.

Avoiding the initiation or resumption of treatment with methotrexate,

leflunomide, or biologic agents for patients with active bacterial

infection, active herpes-zoster viral infection, active or latent

tuberculosis, or acute or chronic hepatitis B or C.

Not prescribing anti-TNF¦Á agents to patients with a history of heart

failure, with a history of lymphoma, or with multiple sclerosis or

demyelinating disorders.

Avoiding the initiation or resumption of methotrexate, leflunomide, or

minocycline for RA patients planning for pregnancy and throughout the

duration of pregnancy and breastfeeding.

http://www.medscape.com/viewarticle/576813

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Not an MD