Assessment of interactions and dosage recommendations of synthetic DMARDs—Evidence-based and consensus-based recommendations based on a systematic literature search

• Published in: Zeitschrift für Rheumatologie Vol. 83; no. Suppl 1; pp. 8 - 19
• Main Authors: Fiehn, C., Leipe, J., Weseloh, C., Bergner, R., Krüger, K.
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01.02.2024
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Biological Products - therapeutic use; Consensus; Drug Interactions; Drug Therapy, Combination; Empfehlungen und Stellungnahmen von Fachgesellschaften; Humans; Immunology; Internal Medicine; Laboratory Medicine; Medicine; Medicine & Public Health; Orthopedics; Rheumatology; Rheumatoide Arthritis; Janus kinase inhibitors; Rheumatoid arthritis; Drug interactions; Pharmakologie; Arzneimittelinteraktionen; Pharmacology; Januskinaseinhibitoren; Disease-modifying antirheumatic drugs
• ISSN: 0340-1855; 1435-1250; 1435-1250
• DOI: 10.1007/s00393-023-01417-3

Conventional synthetic (cs) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) have potential interactions with a multitude of drugs. Furthermore, they sometimes have a lower therapeutic index, particularly in cases of limited organ functions. The aim of this work was to establish evidence-based recommendations on the therapeutic use of DMARDs in the context of drug interactions and dosage recommendations. A systematic literature search was carried out on the issue of drug interactions and dosages in cases of patients with limited kidney function and higher age and suffering from rheumatoid arthritis. A total of 2756 scientific publications were screened and 154 selected of which 68 were scrutinized in detail. Furthermore, the respective product information was also analyzed. A multitude of possible interactions of synthetic DMARDs with different drugs were detected, which were then assessed with respect to the clinical significance and consequences. A consensus process led to making recommendations with which the interactions were classified: A: dangerous combination, B: avoid combination (if possible, pausing DMARD treatment), C: possible combination requiring increased monitoring and potential adjustments in dosage and D: pharmacological interaction without relevance in DMARD standard doses. Apart from that dosage recommendations were established for each csDMARD and tsDMARD depending on kidney function and age. There are 3 primary recommendations and 11 core recommendations on interactions and dosages of csDMARDs and tsDMARDs meant as a practical help for therapeutic decision making and to improve safety in the treatment of rheumatoid arthritis.