title: 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.
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.
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan. miogasaw@juntendo.ac.jp
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Michiaki
authors.initials: M
authors.lastname: Kageyama
authors.forename: Makio
authors.initials: M
authors.lastname: Kusaoi
authors.forename: Shin
authors.initials: S
authors.lastname: Onuma
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kon
authors.forename: Fumio
authors.initials: F
authors.lastname: Sekiya
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Ran
authors.initials: R
authors.lastname: Matsudaira
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Kurisu
authors.initials: K
authors.lastname: Tada
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kempe
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003545:Cysteine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine; D003545:Cysteine; C026535:bucillamine; D008727:Methotrexate