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Gemfibrozil, sold under the brand name Lopid among others, is a medication used to treat abnormal blood lipid levels. [3] It is generally less preferred than statins. [3] [4] Use is recommended together with dietary changes and exercise. [3] It is unclear if it changes the risk of heart disease. [3] It is taken by mouth. [3]
Among atypical adverse effects, myositis can occur in patients under gemfibrozil therapy, especially in those with renal insufficiency or under co-treatment with statins. In contrast, the risk of myopathy is much lower if fenofibrate is used in replacement of gemfibrozil owing to its different pharmacokinetic pathway.
However, the risk was over 10-fold greater if cerivastatin was used, or if the standard statins (atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) were combined with a fibrate (fenofibrate or gemfibrozil) treatment. Cerivastatin was withdrawn by its manufacturer in 2001.
Bayer A.G. added a contraindication for the concomitant use of cerivastatin and gemfibrozil to the package 18 months after the drug interaction was found. [3] The frequency of deadly cases of rhabdomyolysis with cerivastatin was 16 to 80 times higher than with other statins. [4] Another 385 nonfatal cases of rhabdomyolysis were reported.
Fenofibrate (sold under the brand name Tricor among others), is an oral medication of the fibrate class used to treat abnormal blood lipid levels. [3] It is less commonly used compared to statins because it treats a different type of cholesterol abnormality to statins.
Conventional DMARDs are known to be the first-line treatment for rheumatoid arthritis. [9] Treatment can be a monotherapy or in combination with other anti-arthritic medications. Common DMARDs include oral methotrexate, leflunomide, or sulfasalazine. Conventional DMARDs have a slow onset of action and can take 2–3 months to exhibit effect. [9]
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