Introduction
Clinical practice guidelines (CPGs) are instrumental in standardizing
evidence-based diagnostic and treatment protocols in rheumatology
[1]. However, the integrity of these guidelines can be compromised
by conflicts of interest (COIs), both financial and non-financial
[2-4]. Indeed, over the last two decades, several violations of
patient-centered care by clinical practice guidelines, as well as
harmful effects on patients [4,5], have resulted in the
establishment of more stringent COI management policies through global
collaborations [1,6,7]. Given the increasing influence of CPGs on
patients, healthcare professionals, and other stakeholders, rigorous COI
management—including full disclosure of COIs, efforts to minimize COIs
among CPG authors and organizations, and balanced recommendations by
multiple experts—is essential for establishing trustworthy CPGs and
promoting patient-centered care [6-12].
Over the past 30 years since the first introduction of methotrexate for
rheumatoid arthritis treatment, there has been remarkable development in
systematic treatment strategies for rheumatoid arthritis [13]. In
addition, the success of the first biologic therapy, namely tumor
necrosis factor (TNF) inhibitors, has provided further impetus for the
development of other biologics targeting different pathways such as IL-1
inhibitors, IL-6 inhibitors, IL-17 inhibitors, cytotoxic T
lymphocyte-associated antigen-4 (CTLA-4) blockers, and Janus Kinase
(JAK) inhibitors [14]. Due to fierce competition among
pharmaceutical companies, the global market for rheumatoid arthritis was
expected to be worth approximately US$26 billion in 2019 and the
pharmaceutical companies have increasingly marketed their products to
physicians involved in treating and managing patients with rheumatoid
arthritis [15-17]. Given these contexts, authors of rheumatoid
arthritis CPG should properly manage their COI with pharmaceutical
companies. This study aimed to assess the financial relationships
between pharmaceutical companies and CPG authors using publicly
disclosed payment data in Japan.