Abstract
Introduction: Rheumatoid arthritis (RA) is one of the most prevalent chronic inflammatory diseases in the world. The main symptoms of the disease are pain, swelling, numbness and deformities, which can later lead to the destruction of cartilage and joints by bone erosion. Treatment aims to improve functional capacity and quality of life, and to prevent and control joint and extra-articular injuries. Biological disease-modifying antirheumatic drugs (DMCDbio) and synthetic target-specific antirheumatic drugs (DMCDsae) used in the treatment of RA are expensive and have a significant impact on SUS spending. The evaluation of the implementation of incorporated technologies, in terms of use, effectiveness and safety by the Clinical Protocol and Therapeutic Guidelines (PCDT) contributes to the sustainability of SUS and improves equity and access to medicines. The objective of this study was to analyze the utilization profile, persistence, and expenditure on MMCDbio and MMCDsae used for the treatment of RA in the SUS from 2017 to 2021. Methods: This is a retrospective cohort of users who received at least one MMCDbio or MMCDase registered in the Open Health Intelligence Room - Sabeis/Datasus. The overall persistence was evaluated and stratified by gender, therapeutic class, and medication, from time zero until medication interruption or change. The 15 medications standardized by the PCDT were valued based on public purchases registered in the Health Price Bank and active searches with the Ministry of Health, between 2017 and 2021. Expenses were calculated based on the number of APACs registered in the SAI/SUS. Results: Between 2017 and 2021, 91,684 patients were evaluated. The majority were women, aged between 45 and 64 years old, living in the Southeast region. The most widely used group of medications was anti-TNF DMARDs, associated or not with conventional synthetic DMARDs. Among the 10 most commonly used medications or combinations were adalimumab (32.2%), etanercept (15.5%) and golimumab (7.6%). The median overall persistence time was 11 months, being 10 months among women and 13 months among men. People using adalimumab had a median persistence time of 16 months. Expenditure on medicines was R$408,146,527 (2017), R$237,615,290 (2018), R$213,790,222 (2019), R$195,626,575 (2020) and 140,096,142 (2021). It was found that in 2017, adalimumab (33%), etanercept (28%) and golimumab (14%) were the most used DMARDs. An increase in the consumption of adalimumab and certolizumab was observed from 2017 to 2019, with a reduction in the use of other DMARDs, mainly etanercept. In 2019, there was a change in the utilization profile after the incorporation of MMCDsae tofacitinib into the PCDT. Discussion and conclusions: From 2017 to 2021, changes were observed in the utilization and spending profile of MMCDbio and MMCDsae, resulting from the incorporation of new drugs and the entry of biosimilars into the Brazilian market. However, adalimumab, one of the first MMCDbio incorporated, showed better performance in terms of persistence time. This project was funded by DGITS/SECTICS/MS.
