MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

NICE Guidance

 NG100: Rheumatoid arthritis in adults: management, July 2018

 CG177: Osteoarthritis: care and management, February 2014

 Shared care guidelines for disease modifying antirheumatic drugs (DMARDs) 2018

other conventional DMARDs include:

Follow the links for information on the above drugs. All these drugs require regular monitoring consult the BNF for details.

Hydroxychloroquine:

 Royal College of Opthalmologists Clinical Guideline: Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Screening, February 2018. To avoid excessive doses in obese people, doses of hydroxychloroquine should be calculated on the basis of lean body weight.

Methotrexate: 

This is given as a ONCE weekly dose as a single dose on the same day of the week. Folic acid 5mg supplements are advisable. There is little evidence with regard to the use and dose. 5 - 10mg is frequently used, with a gap of 24-48 hours between methotrexate and folic acid doses. Methotrexate may also be given by injection for those patients where the oral route is problematic. To avoid dosing errors with weekly low dose methotrexate, see important safety information in the BNF.

Leflunomide:

It has an active metabolite with a very long half-life which needs to be actively removed, (using colestyramine or activated charcoal), if there are serious adverse effects before starting other DMARDs or before conception. There is increased risk of hepatoxicity (potentially life threatening) with leflunomide in the first 6 months of treatment. Monitor LFTs before treatment and every 2 weeks for the first 6 months then every 8 weeks. See BNF.

Ciclosporin:

It is used when conventional second line therapy is inappropriate or ineffective. There is some evidence that it may retard the rate of erosive progression and improve symptom control in those who only have partial response to methotrexate.

Gold and penicillamine:

warn patients to tell the doctor immediately if sore throat, fever, infection, or non-specific illness, unexplained bleeding and bruising, purpura, mouth ulcers, metallic taste or rashes develop. Also ask patient to report immediately any breathlessness or cough.