Fumaric acid esters

Mechanism not fully understood; conventional hypothesis is based on the idea that dimethyl fumarate interferes with the cellular redox system by modulating intracellular thiols, thereby increasing the level of reduced glutathione. These increased glutathione levels may finally lead to an inhibition of the translocation of NF-κB into the nucleus.

The main activity is considered to be immunomodulatory, producing a shift from Th1/Th17 profile to a Th2 phenotype

daily

Severe disease of the gastrointestinal tract,

Hepatic and/or renal impairment, pregnancy or breastfeeding

Not FDA approved for psoriasis

Methotrexate

A folic acid antagonist. Its main effect is inhibition of DNA synthesis but it also acts directly both on RNA and protein synthesis. MTX also inhibits 5-aminoimidazole-4-carboxamide ribonucleotide tranformylase, leading to an increase in endogenous adenosine which has an anti-inflammatory effect.

weekly

Severe infections, severe liver disease, renal failure, conception (men and women)/breastfeeding, alcohol abuse, bone marrow dysfunction/haematological changes, immunodeficiency, acute peptic ulcer, stomatitis, ulcerations of the oral cavity, significantly reduced lung function

Special caution in geriatric patients

Tofacitinib

Janus kinase (JAK) inhibitor

daily

Active tuberculosis, serious infections such as sepsis or opportunistic infections.

Severe hepatic impairment.

Pregnancy or lactation.

Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in rheumatoid arthritis patients

Currently approved for psoriatic arthritis only EU or USA