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The ability of disease modifying antirheumatic drugs to induce and maintain improvement in patients with rheumatoid arthritis. Epidemiology of DMARDs treatment in Japan

M. Nagashima, G. Shu, K. Yamamoto, S. Yamahatsu, S. Yoshino

Department of Joint Disease and Rheumatism, Nippon Medical School, Tokyo, Japan

ABSTRACT
Objective
The effectiveness of the disease-modifying antirheumatic drugs (DMARDs) methotrexate (MTX), bucillamine (BUC), salazosulphapyridine (SASP) and gold sodium thiomalate (GST) over two courses of treatment with a follow-up period of at least 12 months was eval
uated in 425 patients with rheumatoid arthritis.

Methods
Clinical efficacy was evaluated on the basis of the numbers of painful and swollen joints, morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels before and after treatment. Results were evaluated on the basis of the survival rate (Kaplan-Meier method) and the incidence and types of adverse drug reactions (ADR) following single and combined therapies.

Results
In the first course of treatment, the survival rates for MTX, GST, BUC and SASP were 52.3%, 40.4%, 33.0% and 24.8%, respectively. The rates of development of ADR were 22.9%, 23.5%, 26.3% and 30.0% for BUC, SASP, GST and MTX, respectively. In the second course, the survival rates for MTX, BUC and SASP were 36.6%, 14.1% and 10%, respectively.

Conclusion
DMARDs used in the first course of treatment improved the clinical parameters until the 6th month after initiation of treatment. Combination treatments showed some effectiveness, but because of the high incidence of ADR the survival rate was low. DMARDs used in the second course of treatment were not efficacious and there was no improvement in the survival rate compared to the first course of treatment.

Key words
Rheumatoid arthritis, disease modifying antirheumatic drugs, survival rate, adverse drug reactions, escape phenomenon.

Please address correspondence and reprint requests to: Shinichi Yoshino, MD, Department of Joint Disease and Rheumatism, Nippon Medical School, 1-1-5 Sendagi Bunkyo-Ku, Tokyo 113-8603, Japan.
E-mail: n7148@nms.ac.jp