2022 Volume 34 Issue 1 Pages 16-33
In Japan, 8 biological disease-modifying antirheumatic drugs（bDMARDs）are available for rheumatoid arthritis（RA）.
1. Infliximab（IFX）
IFX is a chimeric anti-TNF antibody. Used intravenously, it works rapidly. Dose escalation and shortening of the interval are approved and effective for patients with high disease activity（HDA）. A bio-free condition（BF）can be introduced.
2. Etanercept（ETN）
ETN is a soluble TNF receptor that can be used by elderly patients since its half-life is short and immunosuppression may be mitigated by discontinuation. ETN can be used by female patients who desire pregnancy.
3. Adalimumab（ADA）
ADA is a fully humanized anti-TNF antibody, however, combination with methotrexate（MTX）is desirable. Early introduction followed by BF can be achieved.
4. Tocilizumab（TCZ）
TCZ is an anti-IL-6 receptor antibody that works well without MTX. Masking of the signs and symptoms of infection can occur and should be considered.
5. Abatacept（ABT）
ABT is a selective T cell co-stimulatory modulator that works well（albeit a little slowly）without MTX. ABT is a safe bDMARDs and can be used by patients with interstitial pneumonia.
6. Golimumab（GLM）
GLM is a fully humanized anti-TNF antibody that works well without MTX. It works slowly but secondary failure is rare due to its low immunogenicity.
7. Certolizumab pegol（CZP）
CZP is a polyethylene glycolated anti-TNF antibody. It does not pass though the placenta and is rarely excreted in breast milk. It can be used by female patients who desire pregnancy. Since CZP works well without MTX and early introduction is approved, we use it for elderly-onset patients with HDA.
8. Sarilumab（SAR）
SAR is a second anti-IL-6 receptor antibody that works well without MTX. We use SAR when patients exhibit secondary failure or side effects with TCZ.
