New drugs for the treatment of rheumatoid arthritis

New pharmacologic treatment options for rheumatoid arthritis (RA) are descr ibed Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for RA but are limited by the risk of adverse effects, especially gastrointestinal and renal toxicity. The therapeutic effects of these agents are mediated p rimarily through inhibition of cyclooxygenase (COX) and prevention of subse quent formation of prostaglandins and related inflammatory mediators. Nonsp ecific COX inhibition appears to be responsible for much of the toxicity of NSAIDs. Agents have been developed that can selectively inhibit the COX-2 isoforms, while sparing COX-1. Celecoxib and other COX-2 inhibitors appear to be no more efficacious than conventional NSAIDs, but offer superior safe ty. COX-2 inhibitors should be considered for patients who are candidates f or NSAID therapy but at risk for GI bleeding. Unlike disease-modifying anti rheumatic drugs (DMARDs), these agents do not alter underlying disease prog ression. Leflunomide is a newer DMARD that reduces pyrimidine synthesis, th us decreasing rheumatoid inflammation. Leflunomide appears to be as effecti ve as methotrexate but, unlike that drug, does not necessitate monitoring f or bone marrow toxicity. Etanercept, the first biological agent with FDA-ap proved labeling for use in RA, has shown efficacy and minimal toxicity, exc ept for injection-site reactions. Other biologicals that have been investig ated for use in RA include infliximab and interleukin-1-receptor antagonist . COX-2 inhibitors, leflunomide, and etanercept are promising new drugs avail able for treating RA. Other agents are underdevelopment.