Conflict between efficacy and economy in rheumatoid arthritis treatment: Iguratimod is found at a compromise

Abstract

h 2 In the last 20 years, while methotrexate (MTX) has become an nchor drug and molecular-targeted drugs such as biologics and anus kinase (JAK) inhibitors have been introduced, rheumatoid rthritis has become a controllable disease. As a result, clinical reission to prevent joint destruction became the primary therapeuic goal. However, in clinical practice, this remission is achieved or at most 50% of patients. Many clinicians are suffering from a ilemma in that they can’t use even if they want to use such effecive drugs as biologics or JAK inhibitors. For any disease, three facors should be considered in the actual treatment strategy: the first s the disease factor (e.g., treatment resistance and complications), he second is the patient factor (e.g., non-illness elements: deteioration of physical and cognitive function due to old age, ecoomic basis), and the third is the treatment factor (e.g., options epending on efficacy, dosage forms and costs). A realistic and reaonable care outcome could be found where the three factors are ell-balanced. Although biologics and JAK inhibitors are highly efective and support the third treatment factor, their immunosupressive effects make it difficult to manage infections and thereby onflict the first disease factor. Moreover, since they are expensive nd dependent on the patient’s financial base, they are against the econd patient factor. The three factors are related to each other. any doctors think that it is better to have more options for the hird treatment factor according to various factors in the first and he second ones. In other words, there is a niche of inexpensive rugs that are reasonably effective and relatively safe, even if they re not so effective as molecular-targeted drugs. Iguratimod is one of those drugs filling that niche. It is a lowost drug classified as a conventional synthetic type of diseaseodifying anti-rheumatic drug (DMARD). Its development began n 1989 when Toyama Chemical Co., Ltd. in Japan discovered a new