Mode of Actions of DMARDs

Messengers mediating information between cells or affecting their activities are so-called cytokines. Cytokines are critical in the pathogenetic process of rheumatoid arthritis, particularly tumour-necrosis-factor (TNF)-α, interleukin (IL)-1 and IL-6. Biologic disease modifying antirheumatic drugs (bDMARDs) inhibit these messengers and thereby influence the disease course.

TNF-α inhibiting biologic DMARDs: Benepali® (etanercept), Cimzia® (certolizumab pegol), Enbrel® (etanercept), Erelzi® (etanercept), Flixabi® (infliximab), Humira® (adalimumab), Inflectra® (infliximab), Remicade® (infliximab), Remsima® (infliximab), Simponi® (golimumab)

IL-1 inhibiting biologic DMARDs: Kineret® (anakinra)

IL-6 inhibiting biologic DMARDs: Kevzara® (sarilumab), RoACTEMRA® (tocilizumab)

Further essential players in the rheumatic inflammatory cascade are B and T lymphocytes. Activity of these cells can be also blocked by biologic DMARDs.

B cell inhibiting biologic DMARD: Rixathon® (rituximab), MabThera® (rituximab)

T cell inhibiting biologic DMARD: Orencia® (abatacept)

The targeted synthetic disease modifying antirheumatic drugs (tsDMARDs) inhibit the activity of Januskinase enzymes.

Januskinase inhibitors: Olumiant® (baricitinib), Xeljanz® (tofacitinib)

Please find further information on the modes of action and the use of DMARDs on the websites of the German Society of Rheumatology (, of the Competence Network Rheumatology ( or on