(7) Evaluation of The Use Profile of Biological Medicines and Synthetic Target-Specific Medicines for The Treatment of Rheumatoid Arthritis in The Sus in The State of Minas Gerais, Brazil

Publication Number: 1052

Background: Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disease characterized by peripheral and symmetric polyarthritis. Biological disease course modifying drugs (bDMARD) such as anti-TNF adalimumab, certolizumab pegol, etanercepte, golimumab, and infliximab, and non-anti-TNF abatacepte, rituximab, and tocilizumab, can be used in cases where there is persistent disease activity, already the synthetic target-specific disease course modifying drugs (sDMARD) such as baricitinib, tofacitinib and upadacitinib are also indicated as alternative therapies after failure of other treatments.

Objectives: To evaluate the profile of the use of bDMARD and sDMARD in the treatment of RA by the Unified Health System (SUS) in Brazil.

Methods: This is a cohort in which patients diagnosed with RA who started using bDMARD and sDMARD, provided by the Specialized Component of Pharmaceutical Services (CEAF) in Minas Gerais, were followed from 2018.

Results: A total of 352 patients were followed, of which 86% were female, with a mean age of 55 years and an estimated disease duration of 12 years. Tofacitinib was the most used drug in the first line of treatment (21.0%), followed by the anti-TNF biological DMARD adalimumab (20.2%) and golimumab (20.2%), and by the anti-CTL4Ig abatacept (6.0%). Of the 352 patients, 69 (19.6%) switched therapy, the main reason for switching being therapeutic failure. Of the patients who failed after using the first biologic, 18,6% used tofacitinib as a second therapeutic option. Among the therapies with the highest rate of use, abatacept had the lowest failure rate (4.8%) followed by tofacitinib (8.1%). Adalimumab was the drug with the highest incidence of therapeutic failure (28.2%). Of the patients who failed after using the first biologic, 4.8% used tofacitinib as a second therapeutic option. .

Conclusions: The data from this study demonstrate that tofacitinib was the most prescribed drug, both in the first and second therapeutic options. This finding may be associated with the greater preference of patients for sDMARD, as they have the advantages of being administered orally and not requiring refrigeration for storage. Access to the medication use profile provided by the SUS is an important tool, as it contributes to better care and optimization of the use of public resources.