Professor Universidade Federal do Recôncavo da Bahia (UFRB) Feira de Santana, Brazil
Background: The complexity and high cost of the treatments comprised by the Pharmaceutical Assistance pose a great challenge to the management of public resources for the purchase of medicines in the Brazilian Unified Health System (SUS) , considering that they are finite resources.
Objectives: To assess the distribution frequencies and trends of biological DMARDs, conventional synthetic DMARDs (csDMARDs), and immunosuppressive agents for rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PA) using administrative data available in the Horus System (HS), a medication information system of the SUS, from 2013 to 2020.
Methods: We conducted a trend analysis through the assessment of the frequency distribution of each drug and therapeutic class in order to characterize the RA, PA, and AS treatment profile in Brazil.
Results: 11,408,671 DMARDs dispensation pharmaceutical units records were identified between January 2013 and December 2020 in Brazil: 36.3% bDMARDs (biological), 39.3% csDMARDs (conventional synthetic) and 24.3% immunosuppressive agents. In the bDMARD group, the proportional distribution was: adalimumab (14.8%) and etanercept (10.6%) followed by infliximab (3.3%), tocilizumab (2.2%), golimumab (2.1%), abatacept (1.2%), certolizumab (1.1%), secukinumab (0.5%), rituximab (0.4%) and ustekinumab (0.004%). The TNF-alpha inhibitors represented 32% and other bDMARDs. 4.3%. In the csDMARD and immunosuppressive agents group the observed proportions were: leflunomide (21.4%), azathioprine (17.4%), hydroxychloroquine (7.8%), cyclosporine (7.0%), methotrexate (6.6%), sulfasalazine (2.2%), chloroquine (1.1%), tofacitinib (0.4%) and cyclophosphamide (0.02%). 13.7% of all dispensations were related to Rheumatoid Arthritis (7%), Psoriatic Arthritis (2.5%), and Ankylosing Spondylitis (4.1%). Seven from 264 ICD-10 codes received 70% of all DMARD dispensations from 2013 to 2020: M05.8 (24.7%), M06.0 (10.7%), M32.1 (9.8%), M45 (8.1%), Z94.0 (6.1%), M05.0 (5.1%) and M06.8 (5.1%). The following six ICD-10 codes distributions ranged from 3.8% to 2.1% and the remaining 14.5% of dispensations were made to 251 distinct ICD-10 codes. Five of the seven predominant ICD-10 codes are related to the highlighted protocols and the two exceptional ones refer to Systemic Lupus Erythematosus (M32.1) and Transplanted Kidney (Z94.0).
Conclusions: It is possible through Horus System to trace a pharmacoepidemiological profile of patients with autoimmune diseases, through the analysis of dispensation and distributions frequencies and carry out a management planning, aiming at an efficient Pharmaceutical Assistance within the Brazilian health system.
