Departamento de Reumatologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
Departamento do curso de Medicina, Centro Universitário de Brasília- Uniceub, Brasília, Distrito Federal, Brazil.
PLoS One. 2019 Mar 1;14(3):e0213219. doi: 10.1371/journal.pone.0213219. eCollection 2019.
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.
类风湿关节炎（RA）的治疗近年来迅速发展。尽管如此，传统的合成疾病修饰药物（csDMARDs）仍然是 RA 治疗的金标准。RA 的治疗费用高昂，这对公共卫生造成了负面影响。鉴于 csDMARDs 的成本相对其他治疗策略较低，因此正确管理此类治疗非常重要。了解每种药物的使用持续时间及其停药原因对医疗从业者很重要，因为这可以改善有关副作用及其正确管理的可用信息。此外，人群中临床实践的数据可以为医疗保健管理人员提供资源分配信息，并优化 csDMARD 的使用，从而降低 RA 的治疗成本。在这项横断面研究中，我们旨在描述巴西公共卫生服务中 csDMARDs 的使用情况，重点是每种药物的使用持续时间和停药原因。这项研究是 REAL 的一部分，REAL 是一项多中心项目，评估了 2015 年 8 月至 10 月来自 11 个风湿病服务机构的 1125 名巴西 RA 患者。对患者进行了临床检查，并对补充检查和病历进行了分析。共纳入 1125 名患者。98.5%为女性，中位年龄为 55.6 岁。分别有 36%和 90.84%的患者使用生物疾病修饰药物（bDMARDs）和 csDMARDs。分析了每种药物的使用持续时间、剂量和停药原因。本研究分析的大多数患者长期使用 csDMARDs，其中甲氨蝶呤的使用持续时间最长。分析了因无效和副作用而中断治疗的指数。了解常见的不良反应可能会提醒主治医生对有效且低成本的治疗组进行适当管理。
