Treatment trends of rheumatoid arthritis in Japan: Changes toward globalization and its unique innovation

Miyasaka, Nobuyuki

doi:10.2492/inflammregen.31.25

Cited by 7 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Europe, treatment guidelines recommend a methotrexate dosage up to 25 mg/week [ 3 ], while in Japan, methotrexate is approved at a dosage of 16 mg/week; however, more than half of Japanese patients with RA are unable to tolerate a dose of 16 mg/week [ 17 ]. The maximum dose of csDMARDs that is approved/can be tolerated by patients in EU5 and Japan may be explained by body weight and body mass index, which are considerably lower in Japanese patients than in patients from EU5 [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Biologic Disease-Modifying Antirheumatic Drug Prescription Patterns Among Rheumatologists in Europe and Japan

et al. 2020

View full text Add to dashboard Cite

Introduction Tumor necrosis factor inhibitors (TNFi) are commonly used as first-line therapy (biologic disease-modifying antirheumatic drug [bDMARD] and targeted synthetic DMARD [tsDMARD]: defined as targeted therapy) for patients with moderate-to-severe rheumatoid arthritis (RA), usually combined with conventional synthetic DMARDs (csDMARDs) but sometimes as monotherapy. If treatment fails, patients cycle to another TNFi (cycling) or switch to a targeted therapy with a different mode of action (MOA; switching). The study aimed to examine prescribing patterns and reasons for current RA treatment practice in Europe (EU5: France, Germany, Italy, Spain, UK) and Japan. Methods Data were collected from the Adelphi Disease Specific Programme™ (DSP; Q1–Q2 2017). Rheumatologists seeing ≥ 10 (EU5) and ≥ 5 (Japan) patients with RA a month completed Patient Record Forms. Patients ≥ 18 years old, with RA diagnosis and complete RA-targeted therapy history were included. Patients were grouped based on first-line targeted therapy class, and on whether first-line targeted therapy was monotherapy (targeted therapy alone) or combination therapy (targeted therapy and csDMARD). Those patients receiving TNFi at first-line and with ≥ 1 targeted therapy were classified as TNFi cyclers or MOA switchers. Univariate analysis compared factors across groups. Patient demographics and characteristics compared across groups; physician reasoning for targeted therapy change; and time to discontinuation of targeted therapy. Results In EU5 and Japan, respectively, 1741 and 147 patients were included; at first-line, 80.8% and 64.6% received TNFi and 76.0% and 77.6% received combination therapy. Overall in EU5, more combination therapy than monotherapy patients reached maximum csDMARD dose before first-line targeted therapy ( P < 0.05); disease severity was higher in patients initiating TNFi versus non-TNFi ( P < 0.05). In Japan, trends were similar but not significant. The most common reason physicians gave for changing therapy following first-line targeted therapy was ‘secondary lack of efficacy’ (EU5: 46.2%; Japan: 53.8%). In EU5 and Japan, respectively, of 365 and 22 patients who received second-line targeted therapy, 52.1% and 54.5% were MOA switchers. In EU5, TNFi cyclers had longer time from diagnosis to second-line targeted therapy initiation than MOA switchers ( P = 0.04). Conclusions TNFis were the most commonly prescribed targeted therapy at first-line. Between 10 and 20% of patients prescribed a TNFi as first-line targeted therapy did so without concomitant csDMARD. Almost half of patients cycled to another TNFi at second-line. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00211-w) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Biologic Disease-Modifying Antirheumatic Drug Prescription Patterns Among Rheumatologists in Europe and Japan

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Therefore, FK506 is often used to prevent graft rejection in patients undergoing organ transplantation (30). In Japan, it is also considered an effective treatment for RA (31); FK506 has been reported to improve ACR20, ACR50 and ACR70 levels to 48.5, 27.2 and 11.7%, respectively (32). FK506 has also been found to improve the Sharp scores of patients (33), directly suppress the differentiation of osteoclasts (by blocking the expression of NFATc1 activated by RANK-RANKL signaling) (34), and suppress IL-8 production by regulating the function of NF-κB (35).…”

Section: Discussionmentioning

confidence: 99%

Anti-receptor activator of nuclear factor κB ligand antibody treatment increases osteoclastogenesis-promoting IL-8 in patients with rheumatoid arthritis

Morita

Shima

Fujimoto

et al. 2019

International Immunology

View full text Add to dashboard Cite

The receptor activator of nuclear factor κB ligand (RANKL) is an important factor for osteoclastogenesis and contributes to the pathology of rheumatoid arthritis (RA); thus, the anti-RANKL antibody (Ab) has been expected to protect joint destruction in RA patients. IL-8 also has osteoclastogenic activity; however, the role of IL-8 in the bone pathology of RA as well as the relation between IL-8 and RANKL remain unclear. In the present study, clinical observation revealed serum IL-8 levels of 611 pg ml −1 in RA patients with anti-RANKL Ab and 266 pg ml −1 in the same patients without anti-RANKL Ab. In vitro assay showed that anti-RANKL Ab induced production of IL-8 from pre-osteoclast-like cells (OCLs), and IL-8 promoted the formation of OCLs from peripheral monocytes even without RANKL activity. We further showed that treatment with FK506 (tacrolimus) possibly inhibits the increase in IL-8 levels in RA patients with anti-RANKL Ab, and in vitro assay confirmed that FK506 suppressed IL-8 production in pre-OCLs. These results suggest that inhibition of RANKL induces the change in osteoclastogenesis-promoting factor from RANKL to IL-8, and FK506 may be a valuable combination drug to support the use of anti-RANKL Ab in treatment of RA.

show abstract

“…The study also included patients with wide range of ages from 18 to 84 years old. The Japanese therapeutic guide line for methotrexate treatment in RA patients in 2011 [9] recommended use of folic acid at doses less than 5 mg/week at 24-48 h after the last methotrexate administration. According to this indication, we divided the RA patients into two groups by the folic acid dose at 5 mg/week as a threshold, and then compared the efficacy and safety of methotrexate between these groups.…”

Section: Discussionmentioning

confidence: 99%

Influence of High-Dose Folic Acid on Methotrexate Efficacies and Safety in Japanese Rheumatoid Arthritis Patients

Kameyama

Kase²,

Kurihara³

et al. 2017

Drug Res (Stuttg)

View full text Add to dashboard Cite

Folic acid dose at ≦5 mg/week has been recommended for rheumatoid arthritis (RA) patients to decrease risk of methotrexate adverse effects. However, higher doses of folic acid is used in some cases. We examined the influence of high-dose folic acid on methotrexate efficacies and safety in Japanese RA patients. 502 RA patients of four hospitals prescribed methotrexate and folic acid were included. These patients were divided into two subgroups according to the threshold of folic acid dose by 5 mg/week. Basic patient characteristics, methotrexate doses, and the efficacies or adverse effects of methotrexate were retrospectively compared between the two patient subgroups. The frequency of folic acid use at doses higher than 5 mg/week was significantly different between the four hospitals (P<0.001). The prevalence of methotrexate adverse effects was not significantly different between the patients taking folic acid less and more than 5 mg/week. However, in the lower dose methotrexate subgroup (≦8 mg/week), the prevalence of patients exhibiting abnormal serum ALT concentrations in the patients using higher (>5 mg/week) dose of folic acid was significantly higher than that in the lower (≦5 mg/week) folic acid-treated subgroup (P=0.029). Folic acid dose between patients taking methotrexate less and more than 8 mg/week was not significantly different. Folic acid dose was dependent on the hospitals, while efficacies and hepatotoxicity of methotrexate was not basically different between patients taking less and more than 5 mg/week of folic acid.

show abstract

Treatment trends of rheumatoid arthritis in Japan: Changes toward globalization and its unique innovation

Cited by 7 publications

References 21 publications

Biologic Disease-Modifying Antirheumatic Drug Prescription Patterns Among Rheumatologists in Europe and Japan

Biologic Disease-Modifying Antirheumatic Drug Prescription Patterns Among Rheumatologists in Europe and Japan

Anti-receptor activator of nuclear factor κB ligand antibody treatment increases osteoclastogenesis-promoting IL-8 in patients with rheumatoid arthritis

Influence of High-Dose Folic Acid on Methotrexate Efficacies and Safety in Japanese Rheumatoid Arthritis Patients

Contact Info

Product

Resources

About