Abstract
The treatment of rheumatoid arthritis (RA) has evolved rapidly in recent years. Nonetheless, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard for RA treatment.The treatment for RA is expensive and this has a negative impact on public health. Given the low cost of csDMARDs compared to those of other treatment strategies, it is important to manage this type of treatment properly. Information on the duration of use of each drug and the reasons for their discontinuation is relevant to medical practitioners as it could improve the information available regarding side effects and their proper management. Moreover, data from clinical practice in the population can provide health care managers with information for resource allocation and optimization of csDMARD use with a consequent cost reduction in the treatment of RA.In this cross-sectional study, we aimed to describe the use of csDMARDs in public health services in Brazil, emphasizing on the duration of use and reasons for discontinuation of each drug. This study is a part of the REAL, a multicenter project that evaluated Brazilian patients with RA from eleven rheumatology services from August to October 2015. Patients were examined clinically, and an analysis of complementary exams and medical records was performed.A total of 1125 patients were included. 98.5% were women with a median age of 55.6 years. 36% and 90.84% patients were using biological disease-modifying drugs (bDMARDs) and csDMARDs, respectively. The duration of use and doses of each medication and the causes of suspension were analyzed.Most of the patients analyzed in this study were using csDMARDs for prolonged periods and methotrexate showed the longest duration of use. Interruption indexes due to ineffectiveness and side effects were analyzed. The knowledge of common adverse effects may alert attending physicians to the proper management of effective and low-cost therapeutic groups.
Highlights
The treatment of rheumatoid arthritis (RA) has evolved rapidly
The inclusion criteria were as follows: patients over 18 years, who were diagnosed with RA based on the American Rheumatism Association (ARA) 1987 or the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 classification criteria, and underwent regular monitoring
We found that 36% and 90.84% were using bDMARDs and csDMARDs, respectively
Summary
The treatment of rheumatoid arthritis (RA) has evolved rapidly. A better understanding of the etiopathogenesis and pathophysiology of this disease allows for the development of drugs targeting new pathways as well as novel therapeutic strategies [1]. Despite the several therapeutic classes, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard, either as monotherapy or in combination with biological disease-modifying drugs (bDMARDs) and synthetic target-specific disease-modifying drugs (tsDMARDs) [2] [3]. In addition to their use during treatment, rheumatology societies worldwide recommend the initiation of csDMARDs treatment for naive patients [4] [5]. The cost of treatment for RA is extremely high and has a negative impact on public health. RA has become one of the most prevalent public health diseases in proportion to the number of patients. [7] Given the low cost of csDMARDs compared to other treatment strategies, it is extremely important to manage this type of treatment properly
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