(6) Evaluation of The Rate of Discontinuation of Treatment with Biological Drugs in Patients with Ankylosing Spondylitis: Pre-Pandemic and Pandemic Period

Publication Number: 1051

Background: Ankylosing Spondylitis (AS) is a chronic inflammatory disease that preferentially affects the spine and is the most frequent rheumatic condition within the group of spondyloarthritis. The prevalence in the population may vary according to location and affects mostly young white males. The Brazilian Unified Health System (SUS) provides treatment for patients diagnosed with AS, and includes in its clinical protocol the biological disease-modifying antirheumatic drugs (bDMAD): adalimumab, etanercepte, infliximab, golimumab, certolizumab, and secuquinumab. Maintenance of drug therapy is critical to treatment success and has an impact on both patients' quality of life and health care costs. There are several factors that may influence adherence, and the pandemic COVID-19 has arrived as a new barrier to this end.

Objectives: To evaluate the epidemiological and clinical profile of patients diagnosed with AS who had biological therapy abandonment as an outcome, as well as to analyze the influence of the pandemic by COVID-19, in this context.

Methods: This is a cohort, in which patients diagnosed with ankylosing spondylitis, with first prescription of bDMAD in the SUS, Brazil, as of 2018 by the State Health Secretariat of the State of Minas Gerais, were followed for at least 6 months. The outcome of treatment discontinuation was evaluated.

Results: Were followed 453 patients, of whom 52.2% were male, with a mean age of 44 years. Most patients were white, representing 61.42% of the total. Of the 205 patients who started treatment with bDMAD before the pandemic, 20% discontinued treatment, and for the 247 patients who started after treatment after the start of the pandemic in March 2020, the percentage of discontinuation was 47.4%. The frequency of treatment discontinuation was 237% higher in the pandemic period compared to the pre-pandemic period. Among patients who discontinued treatment, 35.4% were taking golimumab, 29.1% were taking adalimumab, and 18.4% were using infliximab.

Conclusions: Thus, the study data show that the profile of patients is compatible with the scientific literature and that, as expected, the pandemic had a negative impact on the context of maintenance of pharmacotherapy for the treatment of AS.