Skip to main content

Advertisement

SpringerLink
Log in

Recent trends in use of nonbiologic DMARDs and evaluation of their continuation rates in single and dual combination therapies in rheumatoid arthritis patients in Japan

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Objective

We aim to examine changes in usage of nonbiologic, disease-modifying antirheumatic drugs (DMARDs) and evaluate their continuation rates in Japan.

Methods

We analyzed DMARD treatment data for 3,734 patients with rheumatoid arthritis (RA) from 1998 to 2009 at Juntendo Hospital in Tokyo, Japan. The DMARD usage rate per month was determined to evaluate RA treatment history in the last decade. We also evaluated continuation rates of nonbiologic DMARDs in single and combination therapies and number of nonbiologic DMARD combination therapies used in each patient.

Results

We found that nonbiologic DMARD usage has dramatically changed in the last decade, with the most commonly used DMARD shifting from bucillamine to methotrexate (MTX). MTX showed the highest continuation rate; however, much lower continuation rate was observed when used alone rather than in combination treatments. Further, MTX was also used in the highest number of different combination therapies for a particular patient.

Conclusions

These findings indicate that single MTX treatment may be unable to keep patients in clinical remission or lower disease activity compared with several combination therapies. Recent change in permitted maximum dosage of MTX from 8 to 16 mg/week may improve its efficacy and continuation rate in treating Japanese RA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Landewé RB. American College of Rheumatology recommendations for the treatment of RA: an issue of choices. Nat Clin Pract Rheumatol. 2009;5:8–9.

    Article  PubMed  Google Scholar 

  2. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.

    Article  PubMed  Google Scholar 

  3. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81.

    Article  PubMed  Google Scholar 

  4. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580–8.

    Article  PubMed  Google Scholar 

  5. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, Kerstens PJ, Grillet BA, de Jager MH, et al. Patient preferences for treatment: report from a randomised comparison of treatment strategies in early rheumatoid arthritis (BeSt trial). Ann Rheum Dis. 2007;66:1227–32.

    Article  PubMed  Google Scholar 

  6. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52:3381–90.

    Article  PubMed  CAS  Google Scholar 

  7. Hashimoto J, Garnero P, van der Heijde D, Miyasaka N, Yamamoto K, Kawai S, et al. A combination of biochemical markers of cartilage and bone turnover, radiographic damage and body mass index to predict the progression of joint destruction in patients with rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs. Mod Rheumatol. 2009;19:273–82.

    Article  PubMed  CAS  Google Scholar 

  8. Nakajima M, Ueda N, Ohara H, Abe M, Kinoshita M. A comparative study of the effects of bucillamine and salazosulfapyridine in the treatment of rheumatoid arthritis. Mod Rheumatol. 2009;19:384–9.

    Article  PubMed  CAS  Google Scholar 

  9. Sagawa A, Fujisaku A, Ohnishi K, Mukai M, Yasuda I, Amasaki Y, et al. A multicentre trial of bucillamine in the treatment of early rheumatoid arthritis (SNOW study). Mod Rheumatol. 2011;21:251–7.

    Article  PubMed  Google Scholar 

  10. Kawai S, Takeuchi T, Yamamoto K, Tanaka Y, Miyasaka N. Efficacy and safety of additional use of tacrolimus in patients with early rheumatoid arthritis with inadequate response to DMARDs—a multicenter, double-blind, parallel-group trial. Mod Rheumatol. 2011;21:458–68.

    Article  PubMed  CAS  Google Scholar 

  11. Lee YH, Woo JH, Choi SJ, Ji JD, Bae SC, Song GG. Tacrolimus for the treatment of active rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials. Scand J Rheumatol. 2010;39:271–8.

    Article  PubMed  CAS  Google Scholar 

  12. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.

    Article  PubMed  CAS  Google Scholar 

  13. Ducoulombier V, Solau E, Coquerelle P, Houvenagel E, Siame JL, Desprez X, et al. Long-term results of infliximab therapy in rheumatoid arthritis: experience acquired by the North-Pas-de-Calais hospital network. Joint Bone Spine. 2007;74:56–9.

    Article  PubMed  CAS  Google Scholar 

  14. Iwamoto N, Kawakami A, Fujikawa K, Aramaki T, Kawashiri SY, Tamai M, et al. Prediction of DAS28-ESR remission at 6 months by baseline variables in patients with rheumatoid arthritis treated with etanercept in Japanese population. Mod Rheumatol. 2009;19:488–92.

    Article  PubMed  CAS  Google Scholar 

  15. Tang B, Rahman M, Waters HC, Callegari P. Treatment persistence with adalimumab, etanercept, or infliximab in combination with methotrexate and the effects on health care costs in patients with rheumatoid arthritis. Clin Ther. 2008;30:1375–84.

    Article  PubMed  CAS  Google Scholar 

  16. Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, et al. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol. 2007;17:283–9.

    Article  PubMed  Google Scholar 

  17. Yamanaka H, Inoue E, Tanaka E, Nakajima A, Taniguchi A, Terai C, et al. Influence of methotrexate dose on its efficacy and safety in rheumatoid arthritis patients: evidence based on the variety of prescribing approaches among practicing Japanese rheumatologists in a single institute-based large observational cohort (IORRA). Mod Rheumatol. 2007;17:98–105.

    Article  PubMed  CAS  Google Scholar 

  18. Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J, et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E initiative. Ann Rheum Dis. 2009;68:1086–93.

    Article  PubMed  CAS  Google Scholar 

  19. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46:328–46.

    Article  Google Scholar 

  20. Ichikawa Y, Shinozawa T, Yoshida T, Kameda H, Suzuki Y, Kawai S, et al. Methotrexate and salazosulfapyridine in the long-term treatment of rheumatoid arthritis. Ryumachi. 1995;35:663–70 (in Japanese).

    Google Scholar 

  21. Nagaoka S, Nakamura M, Senuma A, Sekiguchi A. A clinical trial of low dose methotrexate therapy in patients with rheumatoid arthritis. Nihon Rinsho Meneki Gakkai Kaishi. 2005;28:389–97 (in Japanese).

    Google Scholar 

  22. van der Kooij SM, de Vries-Bouwstra JK, Goekoop-Ruiterman YP, van Zeben D, Kerstens PJ, Gerards AH, et al. Limited efficacy of conventional DMARDs after initial methotrexate failure in patients with recent onset rheumatoid arthritis treated according to the disease activity score. Ann Rheum Dis. 2007;66:1356–62.

    Article  PubMed  Google Scholar 

  23. Ortendahl M, Schettler JD, Fries JF. Factors influencing length of time taking methotrexate in rheumatoid arthritis. J Rheumatol. 2000;27:1139–47.

    PubMed  CAS  Google Scholar 

  24. Endresen GK, Husby G. Folate supplementation during methotrexate treatment of patients with rheumatoid arthritis. An update and proposals for guidelines. Scand J Rheumatol. 2001;30:129–34.

    Article  PubMed  CAS  Google Scholar 

  25. Smolen JS, Landewé R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69:964–75.

    Article  PubMed  CAS  Google Scholar 

  26. Attar SM. Adverse effects of low dose methotrexate in rheumatoid arthritis patients. A hospital-based study. Saudi Med J. 2010;30:909–15.

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan

    Michihiro Ogasawara, Michiaki Kageyama, Makio Kusaoi, Shin Onuma, Takayuki Kon, Fumio Sekiya, Kaoru Sugimoto, Ran Matsudaira, Masakazu Matsushita, Kurisu Tada, Kazuo Kempe, Ken Yamaji, Naoto Tamura & Yoshinari Takasaki

Authors
  1. Michihiro Ogasawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michiaki Kageyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Makio Kusaoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shin Onuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takayuki Kon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fumio Sekiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kaoru Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ran Matsudaira
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masakazu Matsushita
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kurisu Tada
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kazuo Kempe
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ken Yamaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Naoto Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yoshinari Takasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michihiro Ogasawara.

About this article

Cite this article

Ogasawara, M., Kageyama, M., Kusaoi, M. et al. Recent trends in use of nonbiologic DMARDs and evaluation of their continuation rates in single and dual combination therapies in rheumatoid arthritis patients in Japan. Mod Rheumatol 22, 831–836 (2012). https://doi.org/10.1007/s10165-012-0606-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-012-0606-0

Keywords

Search

Navigation