MEDICATIONS AND TREATMENTS
The aim of this page is to highlight the main medications used to treat the different types of Inflammatory Arthritis and to give a brief explanation as to how they work. We are not making recommendations as to what medication a person should be taking, Inflammatory Arthritis affects everyone differently and so treatment is always tailored to the individuals needs by their healthcare professionals. We have not included the various side effects for each of the drugs; this information can be found on the leaflets that are supplied with the medications.
CORTICOSTEROIDS, ALSO KNOWN AS STEROIDS
e.g: PREDNISOLONE, DEPO-MEDRONE
Typical dose varies.
Administered by tablets, by injection into inflammed joint, injection into muscle or given intravenously (into a vein).
HOW IT WORKS:
The body produces Corticosteroid hormones that help to control the immune system. Steroid medications are a synthetic version of these hormones, which when taken they block the chemicals in the body that trigger inflammation and suppress the immune system.
Typical dose varies.
Administered by tablets, by injection into inflammed joint, injection into muscle or given intravenously (into a vein).
HOW IT WORKS:
The body produces Corticosteroid hormones that help to control the immune system. Steroid medications are a synthetic version of these hormones, which when taken they block the chemicals in the body that trigger inflammation and suppress the immune system.
DISEASE MODIFYING ANTIRHEUMATIC DRUGS (DMARDS)
DMARDS are a category of otherwise unrelated drugs defined by their use in Inflammatory Arthritis to slow down disease progression.
e.g: METHOTREXATE
Typical dose varies between 7.5mg to 25mg a week.
Administered by tablets or subcutaneous (under the skin) injection.
HOW IT WORKS:
This drug has been available for over 30 years and was originally established for use in cancer treatment and it is still used for that purpose today. However in very small doses it can be very effective for the treatment of different types of Inflammatory arthritis. It acts by suppressing several enzymes involved in the immune system and can slow down the progress of arthritis as well as making significant improvements in general wellbeing by reducing the inflammation.
e.g: SULFASALAZINE
Typical dose between 1.5 and 3 grams per day.
Administered by tablets.
HOW IT WORKS:
Sulfasalazine has been available since the 1940's and it is a combination drug containing an anti-inflammatory compound and an antibiotic. It is unclear how it works but it clearly does work for a large number of people with arthritis. Like Methotrexate it can damp down the immune system.
e.g: LEFLONOMIDE
Typical dose is 10 to 20mg per day.
Administered by tablets.
HOW IT WORKS:
Leflonomide is a relatively new agent, introduced specifically for treating inflammatory arthritis within the last 10 years. It has a particular effect on the lymphocytes which are the main cells involved in the arthritis process. It is likely to regulate the immune system by damping down the overactive lymphocytes.
e.g: AZATHIOPRINE
Typical dose is 2 to 2.5mg per Kg a day.
Administered by tablet.
HOW IT WORKS:
Azathioprine is a cytotoxic drug which is widely used for damping down the immune system. It slows down the rate at which cells divide and the aim is to slow down the rate of cell division amongst the inflammatory cells.
e.g: PENICILLAMINE
Typical dose is 500 to 1000mg a day.
Administered by tablets.
HOW IT WORKS:
Penicillamine is a very old drug for the treatment of arthritis. Its mechanism of action is uncertain, it seems to damp the immune system in a non-specific way. It must be taken as a single dose away from food because otherwise it binds to food and does not get absorbed into the body and therefore will not work.
e.g: HYDROXYCHLOROQUINE
Typical dose is 200 to 400mg a day.
Administered by tablets.
HOW IT WORKS:
Hydroxychloroquine is a treatment for malaria but has been shown to damp down the immune system in a non-specific way.
e.g: CICLOSPORIN
Typical dose is 2.5 to 4mg per kg a day in two divided doses.
Administered by tablets.
HOW IT WORKS:
Ciclosporin is an established treatment to suppress the immune system in patients who are about to undergo kidney or heart transplant. Its effects on the immune system have been used for the treatment of patients with inflammatory arthritis and it does seem to have an influence on the activity of the arthritis.
e.g: METHOTREXATE
Typical dose varies between 7.5mg to 25mg a week.
Administered by tablets or subcutaneous (under the skin) injection.
HOW IT WORKS:
This drug has been available for over 30 years and was originally established for use in cancer treatment and it is still used for that purpose today. However in very small doses it can be very effective for the treatment of different types of Inflammatory arthritis. It acts by suppressing several enzymes involved in the immune system and can slow down the progress of arthritis as well as making significant improvements in general wellbeing by reducing the inflammation.
e.g: SULFASALAZINE
Typical dose between 1.5 and 3 grams per day.
Administered by tablets.
HOW IT WORKS:
Sulfasalazine has been available since the 1940's and it is a combination drug containing an anti-inflammatory compound and an antibiotic. It is unclear how it works but it clearly does work for a large number of people with arthritis. Like Methotrexate it can damp down the immune system.
e.g: LEFLONOMIDE
Typical dose is 10 to 20mg per day.
Administered by tablets.
HOW IT WORKS:
Leflonomide is a relatively new agent, introduced specifically for treating inflammatory arthritis within the last 10 years. It has a particular effect on the lymphocytes which are the main cells involved in the arthritis process. It is likely to regulate the immune system by damping down the overactive lymphocytes.
e.g: AZATHIOPRINE
Typical dose is 2 to 2.5mg per Kg a day.
Administered by tablet.
HOW IT WORKS:
Azathioprine is a cytotoxic drug which is widely used for damping down the immune system. It slows down the rate at which cells divide and the aim is to slow down the rate of cell division amongst the inflammatory cells.
e.g: PENICILLAMINE
Typical dose is 500 to 1000mg a day.
Administered by tablets.
HOW IT WORKS:
Penicillamine is a very old drug for the treatment of arthritis. Its mechanism of action is uncertain, it seems to damp the immune system in a non-specific way. It must be taken as a single dose away from food because otherwise it binds to food and does not get absorbed into the body and therefore will not work.
e.g: HYDROXYCHLOROQUINE
Typical dose is 200 to 400mg a day.
Administered by tablets.
HOW IT WORKS:
Hydroxychloroquine is a treatment for malaria but has been shown to damp down the immune system in a non-specific way.
e.g: CICLOSPORIN
Typical dose is 2.5 to 4mg per kg a day in two divided doses.
Administered by tablets.
HOW IT WORKS:
Ciclosporin is an established treatment to suppress the immune system in patients who are about to undergo kidney or heart transplant. Its effects on the immune system have been used for the treatment of patients with inflammatory arthritis and it does seem to have an influence on the activity of the arthritis.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)
e.g: MELOXICAM
Typical dose is 15mg daily.
Administered by tablets.
e.g: IBUPROFEN
Typical dose is 400mg to 800mg every 4 to 6 hours.
Administered by tablets.
e.g: DICLOFENAC
Typical dose is 50mg 3 to 4 times a day, 75mg twice a day or Diclofenac extended-release 100mg once a day.
Administered by tablets.
HOW THEY WORK:
Prostaglandins are produced in the cells of the body by the enzyme Cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both of these enzymes produce Prostaglandins that promote inflammation, pain and fever. NSAIDS block COX enzymes from producing Prostaglandins, which in turn reduces inflammation and pain.
BIOLOGICS
Biologics are the newest types of medication that are used to treat the different forms of Inflammatory Arthritis. They have been designed to target and block particular chemicals or cells involved in the body's immune system response which causes inflammation. By targeting these chemicals or cells inflammation and swelling are reduced in joints, which leads to a reduction in bone and joint damage.
ANTI-TNF'S
e.g: ADALIMUMAB
Typical dose is 40mg once every 2 weeks.
Administered by subcutaneous (under the skin) injection.
e.g: CERTOLIZUMAB
Typical dose is 200mg once every 2 weeks.
Administered by subcutaneous (under the skin) injection.
e.g: ETANERCEPT
Typical dose is 50mg once or twice a week.
Administered by subcutaneous (under the skin) injection.
e.g: INFLIXIMAB
Typical dose is 3mg per kg of weight every 8 weeks.
Administered by infusion in hospital.
e.g: GOLIMUNAB
Typical dose is 50mg given on the same day every month.
Administered by subcutaneous (under the skin) injection.
HOW THEY WORK:
All of the Anti-TNF'S work by blocking a chemical messenger involved in inflammation called Tumour Necrosis Factor (TNF). Each of the above drugs does this in a slightly different way and so it can take a bit of trial and error to see which one a person responds to the best.
TOCILIZUMAB
Brand Name: ROACTEMRA
Typical dose starts at 4mg per kg of weight and can be increased to 8mg per kg of weight every 4 weeks.
Administered by intravenous (into a vein) infusion in hospital or weekly injections.
HOW IT WORKS:
Tocilizumab works by targeting another small protein in the body that causes inflammation called Interleukin 6 (IL-6).
RITUXIMAB
Brand Name: MABTHERA
Typical dose is 1000mg on two occasions given two weeks apart, further doses are then usually given every 6 to 12 months.
Administered by intravenous (into the vein) infusion in hospital.
HOW IT WORKS:
Rituximab works by targeting a molecule called CD20 which is found in a set of white blood cells called Lymphocytes.
ABATACEPT
Brand Name: ORENCIA
Typical dose varies depending on the patients weight, after the first dose it is given 2 weeks later and then again 2 weeks after that and then monthly thereafter.
Administered by intravenous (into the vein) infusion in hospital or weekly injections.
HOW IT WORKS:
Abatacept works by blocking the activation of T-cells which are involved in inflammation.
COSENTYX
Brand Name: SECUKINUMAB
Cosentyx is given via an injection under your skin (Subcutaneous Injection). This is done by using a SensoReady injection pen. Dose varies between 150mg or 300mg, your consultant will decide how much you need. After the first dose you will have further weekly injections at weeks 1, 2 and 3. From week 4 you will receive monthly injections.
HOW IT WORKS:
Cosentyx has been developed for people with Psoriatic Arthritis. It belongs to a group of biological medicines called Interleukin (IL) Inhibitors. It works by neutralising the activity of a protein called IL-17A, which causes an important role in causing inflammation in diseases such as Psoriatic Arthritis.
BIOSIMILAR MEDICINES
Biosimilars started to be manufactured for inflammatory arthritis patients and approved by the European regulatory authorities once the patents in place on the original biological medicines expired. A biosimilar medicine is a biological medicine that is highly similar and clinically equivalent in terms of quality, safety and efficacy to an existing biological medicine that has already been authorised. The active substance of a biosimilar medicine is similar but not identical to the original biological medicine. For the biosimilar to get approval the makers of it must prove that it will work the same way as the biological drug it is modelled after. This means it will be as safe and effective.
The biosimilars being used by the Islands Rheumatology team are:
Imraldi and Amgevita - both biosimilars of Adalimumab (Humira)
Benepali - biosimilar of Etanercept (Enbrel)
Inflectra - biosimilar of Infliximab (Remicade)
Truxima - biosimilar of Rituximab (Mabthera)
OTHER NON-BIOLOGICAL MEDICATION
APREMILAST
Brand Name: OTEZLA
Apremilast is a non-biological medication that has shown to be affective against Psoriasis and Psoriatic Arthritis.
Typical Dose: 30mg Tablets
Administered orally twice a day - one in the morning and one at night
How it Works: Apremilast is a selective inhibitor of the enzyme Phosphodiesterase 4 or PDE4 and inhibits spontaneous production of TNF-Alpha from human rheumatoid synovial cells. By doing this it controls much of the inflammatory action within cells, which can affect the level of inflammation in patients.
ANTI-TNF'S
e.g: ADALIMUMAB
Typical dose is 40mg once every 2 weeks.
Administered by subcutaneous (under the skin) injection.
e.g: CERTOLIZUMAB
Typical dose is 200mg once every 2 weeks.
Administered by subcutaneous (under the skin) injection.
e.g: ETANERCEPT
Typical dose is 50mg once or twice a week.
Administered by subcutaneous (under the skin) injection.
e.g: INFLIXIMAB
Typical dose is 3mg per kg of weight every 8 weeks.
Administered by infusion in hospital.
e.g: GOLIMUNAB
Typical dose is 50mg given on the same day every month.
Administered by subcutaneous (under the skin) injection.
HOW THEY WORK:
All of the Anti-TNF'S work by blocking a chemical messenger involved in inflammation called Tumour Necrosis Factor (TNF). Each of the above drugs does this in a slightly different way and so it can take a bit of trial and error to see which one a person responds to the best.
TOCILIZUMAB
Brand Name: ROACTEMRA
Typical dose starts at 4mg per kg of weight and can be increased to 8mg per kg of weight every 4 weeks.
Administered by intravenous (into a vein) infusion in hospital or weekly injections.
HOW IT WORKS:
Tocilizumab works by targeting another small protein in the body that causes inflammation called Interleukin 6 (IL-6).
RITUXIMAB
Brand Name: MABTHERA
Typical dose is 1000mg on two occasions given two weeks apart, further doses are then usually given every 6 to 12 months.
Administered by intravenous (into the vein) infusion in hospital.
HOW IT WORKS:
Rituximab works by targeting a molecule called CD20 which is found in a set of white blood cells called Lymphocytes.
ABATACEPT
Brand Name: ORENCIA
Typical dose varies depending on the patients weight, after the first dose it is given 2 weeks later and then again 2 weeks after that and then monthly thereafter.
Administered by intravenous (into the vein) infusion in hospital or weekly injections.
HOW IT WORKS:
Abatacept works by blocking the activation of T-cells which are involved in inflammation.
COSENTYX
Brand Name: SECUKINUMAB
Cosentyx is given via an injection under your skin (Subcutaneous Injection). This is done by using a SensoReady injection pen. Dose varies between 150mg or 300mg, your consultant will decide how much you need. After the first dose you will have further weekly injections at weeks 1, 2 and 3. From week 4 you will receive monthly injections.
HOW IT WORKS:
Cosentyx has been developed for people with Psoriatic Arthritis. It belongs to a group of biological medicines called Interleukin (IL) Inhibitors. It works by neutralising the activity of a protein called IL-17A, which causes an important role in causing inflammation in diseases such as Psoriatic Arthritis.
BIOSIMILAR MEDICINES
Biosimilars started to be manufactured for inflammatory arthritis patients and approved by the European regulatory authorities once the patents in place on the original biological medicines expired. A biosimilar medicine is a biological medicine that is highly similar and clinically equivalent in terms of quality, safety and efficacy to an existing biological medicine that has already been authorised. The active substance of a biosimilar medicine is similar but not identical to the original biological medicine. For the biosimilar to get approval the makers of it must prove that it will work the same way as the biological drug it is modelled after. This means it will be as safe and effective.
The biosimilars being used by the Islands Rheumatology team are:
Imraldi and Amgevita - both biosimilars of Adalimumab (Humira)
Benepali - biosimilar of Etanercept (Enbrel)
Inflectra - biosimilar of Infliximab (Remicade)
Truxima - biosimilar of Rituximab (Mabthera)
OTHER NON-BIOLOGICAL MEDICATION
APREMILAST
Brand Name: OTEZLA
Apremilast is a non-biological medication that has shown to be affective against Psoriasis and Psoriatic Arthritis.
Typical Dose: 30mg Tablets
Administered orally twice a day - one in the morning and one at night
How it Works: Apremilast is a selective inhibitor of the enzyme Phosphodiesterase 4 or PDE4 and inhibits spontaneous production of TNF-Alpha from human rheumatoid synovial cells. By doing this it controls much of the inflammatory action within cells, which can affect the level of inflammation in patients.
