Tabel 2.2 DMARDs yang digunakan pada pengobatan RA (14)Active substanceDosageStrength ofRecom-mendationWhen?Frequent adverse effects

Abatacept10 mg/kg BW/ 4 weeks after induction phaseAs 1st or 2nd bDMARDFollowing inadequateresponse to 2 cDMARDsHyperlipidemia, headache, dizziness, drowsiness, bronchitis, coughing, upper airway infections (including tracheitis, nasopharyngitis), rhinitis, abdominal pain, nausea, diarrhea, dyspepsia, skin rash, herpes simplex, urinary t ract infection, tiredness, weight loss, hypertension, flushing

Adalimumab40 mg/2 weeksAs 1st or 2nd bDMARDfollowing inadequateresponse to 2cDMARDsDecreased hemoglobin concentration, hypertension, headache, dizziness,drowsiness, upper airway infections,rhinitis, sinusitis, bronchitis, increased coughing, pneumonia, nausea, diarrhea, sore throat, elevated transaminases, reactions at injection site, skin rash,pruritus, herpes simplex, urinary tract infection, weight loss, influenza

Anakinra100 mg/dayAs alternative to 1st or 2nd bDMARDReactions at injection site, headache

Antimalarial drugs4 mg chloroquine/kg or >6.5 mg hydroxychloroquine/kg BW/dayAs alternative to 2nd cDMARD or in combinationWith cDMARDsNausea, lack of appetite, diarrhea

Azathioprine23 mg/kg BW/day-As alternative to 2nd cDMARDNausea, vomiting, diarrhea, leukopenia, anemia, infection, drug fever

Certolizumab200 mg/ 2 weeks after induction phaseAs 1st or 2nd bDMARDfollowing inadequateresponse to 2cDMARDsUrinary tract infection, herpes simplex, upper airway infections, dizziness, skin rash, pruritus, exhaustion, pyrexia, pain and reddening at site of administration

Cyclosporine2.53.5 mg/kg BW/dayAs alternative to 2ndcDMARD or in combinationwith cDMARDsLack of appetite, nausea and occasional vomiting, diarrhea, muscle twitching and cramp may indicate magnesium deficiency, slight trembling of hands, slight increase in body hair, swelling and inflammation of gums, hypertension,tiredness

Etanercept50 mg/weekAs 1st or 2nd bDMARD following inadequate response to 2cDMARDsIrritation at injection site, infections

Tabel 2.2 DMARDs yang digunakan pada pengobatan RA (14) (Lanjutan)Golimumab50 mg/monthAs 1st or 2nd bDMARDfollowing inadequateresponse to 2cDMARDsUpper airway infections (nasopharyngitis, pharyngitis, laryngitis, rhinitis), bacterial infections (e.g., inflammation of subcutaneous tissue), viral infections (e.g., influenza and herpes), bronchitis,sinusitis, superficial fungal infections, anemia, allergic reactions (bronchospasm, hypersensitivity, urticaria), autoantibody positive, depression, sleeplessness, dizziness, paresthesias,headache, hypertension, obstipation, dyspepsia, gastrointestinal and abdominal pain, nausea, elevated ALT/GPT levels, elevated AST/GOT levels, alopecia, dermatitis, itching, skin rash, fever, asthenia, reaction at injection site (e.g., erythema, urticaria, induration, pain, bruising, itching, irritation and paresthesias), delayed wound healing, thoracic symptoms

Infliximab35 mg/kg BW every 8weeks after inductionphaseAs 1st or 2nd bDMARDfollowing inadequateresponse to 2cDMARDsHeadache, dizziness, drowsiness, infections of upper and lower respiratory tract (e.g., sinusitis, pneumonia), nausea, diarrhea, elevated transaminases,urticaria, skin rash, pruritus, reactions to infusion

Leflunomide1020 mg/dayAs alternative to 1st or2nd cDMARD or incombination withcDMARDsDiarrhea, nausea, vomiting, abdominal pain, mouth ulcers, elevated liver parameters, leukocytopenia, headache, dizziness, asthenia, hypertension, eczema, hair loss, skin rash, itching, weight loss, mutagenicity, teratogenicity (both in animal experiments)

Methotrexate1025 mg/weekAs 1st cDMARD or incombination withcDMARDs and especiallybDMARDsStomatitis, hair loss, nausea, vomiting, elevated transaminases

Parenteral gold50 mg/ 2 weeks afterInitial phaseAs alternative to 2nd cDMARDDermatitis, stomatitis, pruritus, eosinophilia, proteinuria, deposits on cornea/lens if gold dose >1500 mg (harmless), metallic taste

RituximabTwo doses of 1000 mgat a 2-week intervalevery 612 monthsAs 2nd bDMARDfollowing inadequateresponse to 2cDMARDsAirway infections, reactions to infusion, influenza-like symptoms, infections, transitory hyperuricemia (15%)

Tabel 2.2 DMARDs yang digunakan pada pengobatan RA (14) (Lanjutan)Sulfasalazine2 g/day after initialphaseAs alternative to 1st or 2nd cDMARD or in combination treatmentwith cDMARDsExanthema, pruritus, nausea, abdominal pain, lack of appetite, hyperchromasia, oligospermia, reversible loss of fertility in men, headache, feeling of weakness, tiredness

Tocilizumab8 mg/kg BW every 28 DaysAs 1st or 2nd bDMARDfollowing inadequateresponse to 2cDMARDsSkin and subcutaneous infections, pneumonia, oral herpes simplex, herpes zoster, mouth ulcers, gastritis, exanthema, pruritus, headache, dizziness, elevated transaminases, hypertension, leukopenia, neutropenia, conjunctivitis