Key Points
2
Table 2. Agents Used in Treating RA
Drug Category Definitions
Methotrexate (MTX) A disease modifying antirheumatic drug (DMARD)
Used either oral or subcutaneous
DMARDs
a
Traditional/conventional DMARDs including
hydroxychloroquine (HCQ), leflunomide (LEF),
methotrexate or sulfasalazine (SSZ) (excludes azathioprine,
cyclosporine, minocycline and gold
b
). It does not include
tofacitinib, which is considered separately.
DMARD monotherapy Most oen defined as the use of MTX monotherapy, but
may also be SSZ, HCQ, or LEF
Double DMARD therapy MTX+SSZ, MTX+HCQ, SSZ+HCQ, or combinations
with LEF
Triple DMARD therapy MTX+SSZ+HCQ
DMARD combination
therapy
Double or triple traditional/conventional DMARD therapy
Tofacitinib Oral synthetic small molecule
Biologics
TNFi biologic or non-TNF biologic (excludes anakinra
a
)
TNFi biologics Adalimumab, certolizumab pegol, etanercept, golimumab
or infliximab
Non-TNF biologics
Abatacept, rituximab or tocilizumab (excludes anakinra
a
)
Low dose glucocorticoid ≤10 mg/day of prednisone (or equivalent).
High dose glucocorticoid >10 mg/day of prednisone (or equivalent) and ≤60 mg/day
with a rapid taper (e.g., COBRA regimen
6
)
c
Short-term glucocorticoid <3 month treatment
a
Anakinra was considered but not included in these guidelines due to its infrequent use in RA and
lack of new data since 2012.
b
Azathioprine, cyclosporine, minocycline and gold were considered but not included in these
guidelines due to their infrequent use in RA and/or lack of new data since 2012.
c
Regimen based on that described in the Combinatietherapie Bij Ruematoide Artritis (COBRA).
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