Disease modifying antirheumatic drugs: longterm safety issues.

The trend for more aggressive management of rheumatoid arthritis includes earlier introduction of disease modifying antirheumatic drugs (DMARD). As patients may continue their therapy for several decades instead of several years, the evaluation of benefit versus risk of DMARD with particular emphasis on longterm safety is essential. Longterm safety assessment is difficult for a number of reasons: there are relatively few trials that have followed patients beyond 5 years and the use of a combination of DMARD therapy with nonsteroidal antiinflammatory drugs and corticosteroids complicates the assessment of an observed adverse event with a particular drug. This review of longterm studies incorporating DMARD provides insight into adverse events associated with currently available DMARD.