Disease-modifying antirheumatic drugs. Potential effects in older patients

Drugs & Aging
G Gardner, D E Furst

Abstract

Disease-modifying antirheumatic drugs (DMARDs) are frequently used in rheumatoid arthritis. A number of physiological changes occur in the elderly which may modify the use of these medications. The most commonly used DMARDs are antimalarial drugs (particularly hydroxychloroquine), sulfasalazine and methotrexate. The principal mechanism of action of the antimalarials relates to the fact that they change intracellular pH, which downregulates numerous immune functions. Hydroxychloroquine is metabolised to 3 metabolites and has a very low clearance. It is moderately effective in dosages up to 6.4 mg/kg/day. While it is not the most effective of the DMARDs, it is the least toxic. Sulfasalazine is a prodrug which is enzymatically split in the bowel to form sulfapyridine (the principal active metabolite) and 5-aminosalicylic acid. The metabolism of sulfasalazine is complex and, to some extent, genetically determined. The mechanism of action of the drug is not well understood, but involves decreased production of cytokines and decreased proliferative response of lymphocytes. It may slow the rate of bony damage associated with rheumatoid arthritis. Nearly 50% of the patients who are prescribed sulfasalazine continue to receive the drug ...Continue Reading

Citations

Oct 26, 2005·Drugs & Aging·Ignazio OlivieriAngela Padula
Sep 5, 2009·Drugs & Aging·Juan Ignacio Villa-Blanco, Jaime Calvo-Alén
Jun 12, 2012·The American Journal of Medicine·Leslie R HarroldBecky A Briesacher
Aug 1, 2009·Archives of Pathology & Laboratory Medicine·Amy E Noffsinger
May 25, 2005·Clinics in Geriatric Medicine·Veena K Ranganath, Daniel E Furst
Mar 21, 2007·Rheumatic Diseases Clinics of North America·Veena K Ranganath, Daniel E Furst

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