UPDATE ON RHEUMATIC DMARDS

WHAT’S IN A NAME

• Conventional dmard
• Biologic dmard
• Targeted small molecule

TIMELINE DMARDS

• Timeline of when drugs hit market
• Exciting field, many new drugs in last 20 years, particularly RA, SpA

NEW DMARD IN RA

• Jak inhibitors
• Tofacitinib, Baricitinib, upadacitinib

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• Jak inhib how work immunology slide

JAK INHIB

• What approved for
• RA, PsA, Crohns,
• Being studied in SpA, SLE, DM, UC
• Role outside rheum - IBD, heme

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• Role in tx of RA - first line after failure cDMARD, should be an option on same level as humira

RISKS/AE

• infection
• Shingles reactivation *
• High dose with VTE
• Hepatotoxicity
• Bowel perforation

JAK INHIB

• Unique feautures
• Pts like them - oral
• Act more quickly - 8 wks rather than 12 with TNFi
• Are they any cheaper? Price?
• Monitoring parameters similar q3 mo
• Role outside rheum?

NEW DMARDS IN SPA

• IL17
• IL12/23
• Jak inhib

NEW DRUGS IN GCA

• Actemra
• Giacta trial
• Current study with pmr
• When use?
• When refer?
• Why? Helps reduce steroid burden in your pts with DM, osteoporosis, CHF

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• How actemra works

NEW DRUGS GOUT

• Febuxostat
• Recent trial with increased All cause CV mortality
• So when use?
• Second line behind allopurinol
• Lesinurad

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• How febuxostat works

NEW DRUGS IN SLE

• Benlysta newest
• Current studies - anifrolumab, xeljanz

BEHCETS

• Apremilast

NEW OSTEOPOROSIS DRUGS

• Evenity
• Slide on how works
• Who would we use it in

NEW DRUGS IN OA