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Causes of synthetic disease-modifying drug discontinuation in rheumatoid arthritis: Data from a large real-life cohort. 2019
Ana Paula Monteiro Gomides, and
Cleandro Pires de Albuquerque, and
Ana Beatriz Vargas Santos, and
Rodrigo Balbino Chaves Amorim, and
Manoel Barros Bértolo, and
Paulo Louzada Júnior, and
Isabela Araújo Santos, and
Rina Dalva Neubarth Giorgi, and
Nathalia de Carvalho Sacilotto, and
Sebastião Cezar Radominski, and
Fernanda Maria Borghi, and
Maria Fernanda B Resende Guimarães, and
Maria Raquel da Costa Pinto, and
Gustavo Gomes Resende, and
Karina Rossi Bonfiglioli, and
Henrique Carriço da Silva, and
Maria de Fátima Lobato da Cunha Sauma, and
Marcel Lobato Sauma, and
Júlia Brito de Medeiros, and
Ivânio Alves Pereira, and
Gláucio Ricardo Wernwer de Castro, and
Claiton Viegas Brenol, and
Ricardo Machado Xavier, and
Licia Maria Henrique da Mota, and
Geraldo da Rocha Castelar Pinheiro
Departamento de Reumatologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
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.
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