Non-Biologic DMARDs

folate antimetabolite

Otrexup

single weekly dose

CBC, LFTs, Screen, chest x ray

most efficacious non-biologic, considered first line treatment for most patients.

inhibits pyrimidine synthesis

Arava

daily

none

No myelosuppression, similar efficacy to moderate doses of methotrxate. May be used in place of or in combination with MTX.

unknown

Plaquenil

daily or BID

ophthalmic exam

no myelosuppressive or hepatic adverse events, so it can be safer than the alternatives. However, lower efficacy.

metabolized to sulfapyridine and 5-ASA

Azulfidine

BID

CBC

can be used in patients with mild disease or used in combination with MTX. May cause yellow-orange discoloration of bodily fluids, and should not be used in patients who have a sulfa allergy or are hepatically impaired.