Japan College of Rheumatology guideline for the use of methotrexate in patients with rheumatoid arthritis

Abstract

Methotrexate (MTX), the anchor drug in the current treatment strategy for rheumatoid arthritis (RA), was first approved for treatment of RA in Japan in 1999 at the recommended dose of 6–8 mg/week; it was approved as first-line drug with the maximum dose of 16 mg/week in February 2011. However, more than half of Japanese patients with RA are unable to tolerate a dose of 16 mg/week of MTX. Moreover, some serious adverse events during the treatment with MTX, such as pneumocystis pneumonia (PCP) and lymphoproliferative disorders (LPD) have been observed much more frequently in Japan than in other countries. Therefore, this article, an abridged English translation summarizing the 2016 update of the Japan College of Rheumatology (JCR) guideline for the use of MTX in Japanese patients with RA, is not intended to be valid for global use; however, it is helpful for the Japanese community of rheumatology and its understanding might be useful to the global community of rheumatology.

Keywords:

• Guideline
• Japan College of Rheumatology
• methotrexate
• rheumatoid arthritis

Acknowledgments

The authors thank to Editage Japan for editing the manuscript, which fee was supported by Research on rare and intractable diseases, Health and Labour Sciences Research Grant H29-028.

Conflict of interest

HK has received consulting fees and/or speaker fees from AbbVie GK, Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eli Lilly and Company, Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma, Novartis Pharma K.K., and Sanofi K.K., and has received research grants from AbbVie GK, Asaki Kasei Pharma, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma, Novartis Pharma K.K., and Sanofi K.K.

TF has received a research grant and/or speaker fee from Pfizer Japan Inc., Ono Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Mitsubishi Tanabe Pharma, Eisai Co., Ltd., AbbVie GK, and Astellas Pharma Inc.

AN has received consulting or speaker fees from Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo Healthcare Co., Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma, Novartis Pharma K.K., Pfizer Japan Inc., Taisho Toyama Pharmaceutical Co., Ltd., and has received research grants from Kissei Pharmaceutical Co., Ltd.

KK has received speaker fee from Mitsubishi Tanabe Pharma.

MH has received speaker fees from Mitsubishi Tanabe Pharma, Chugai Pharmaceutical Co., Ltd., and Eli Lilly and Company, research grants from Abbvie GK, Ayumi Co., Ltd., Eisai Co., Ltd., Nippon-Kayaku Co., Ltd., Taisho-Toyama Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma, and Teijin Pharma Co., Ltd.

YS has received research funding from Chugai Pharmaceutical Co., Ltd., and Teijin Pharma Co., Ltd., has received honoraria or fees for promotional materials from Pfizer Japan Inc., Eisai Co., Ltd., Asaki Kasei Pharma, and Ayumi Co., Ltd. All other authors declared no conflicts of interest.