DMARDs (methotrexate + chloroquine + leflunomidum + cyclosporin A + sulfasalazine + OM 89)

This is a combination regimen of disease-modifying antirheumatic drugs (DMARDs) used primarily in the treatment of rheumatoid arthritis and other autoimmune diseases. The combination includes: - **Methotrexate**: An antimetabolite and antifolate agent that inhibits dihydrofolate reductase, leading to suppression of DNA synthesis and immune cell proliferation. - **Chloroquine**: An antimalarial with immunomodulatory effects, thought to inhibit toll-like receptor signaling and reduce inflammation. - **Leflunomidum (leflunomide)**: Inhibits dihydroorotate dehydrogenase, blocking pyrimidine synthesis required for lymphocyte proliferation[1][3][9]. - **Cyclosporin A**: A calcineurin inhibitor that suppresses T-cell activation by inhibiting interleukin-2 transcription[6][7][10]. - **Sulfasalazine**: Has anti-inflammatory and immunomodulatory properties; its mechanism involves inhibition of prostaglandin synthesis and possibly modulation of cytokine production. - **OM 89**: Also known as Uro-Vaxom, an oral immunostimulant derived from Escherichia coli extracts; it modulates immune responses but is less commonly included in standard DMARD regimens. These agents are combined to achieve better control over autoimmune inflammation by targeting different pathways involved in immune activation. Combination therapy can be more effective than monotherapy but may increase the risk of adverse effects such as hepatotoxicity, infections, gastrointestinal symptoms, hypertension, or hematologic abnormalities[2][3].