Department of Management and Incorporation of Technologies in Health (DGITS)/Ministry of Health (MH), Brazil
Background: Psoriasis is a prevalent immune-mediated disease that affects the skin and has a relapsing profile. The treatment is offered by the Brazilian Public Health System (SUS) in accordance with the guidelines recommended by the National Committee for Health Technology Incorporation (Conitec), published in September 2019 and updated in October 2021.
Objectives: To monitor the use of biological treatment for psoriasis in the SUS following Conitec's recommendation on disease guidelines.
Methods: This is a real-word study carried out with retrospective, administrative and national data on medication dispensing, extracted from the Outpatient Health System Information (SIA-SUS) using the Open Room for Health Intelligence Situation (SABEIS-SUS), corresponding to the period from October 2019 to September 2022. Data from adult individuals (≥18 years old) diagnosed with psoriasis (vulgar, generalized pustular, gutata and other psoriasis) and who were using biological treatment (etanercept, adalimumab, secukinumab, ustekinumab and risankizumab) were included. Descriptive analysis of baseline demographic, clinical, and treatment characteristics and analysis of medication use data were performed.
Results: A total of 43.069 adult patients diagnosed with psoriasis were identified and 15.476 (35.93%) were using biological treatment. The mean age of the individuals included was 48.71 years [Standard Deviation (SD) = 14,55], most were male (52.67%) and 10.09% lived in Brazilian states capitals. Most individuals were diagnosed with vulgar psoriasis (92.92%) and the highest proportion used adalimumab (39,14%) at baseline. The number of individuals using biological treatment progressively increased and went from 372 (October 2019) to 13.879 (September 2022), an increase of 3,630.91%. The mean number of new users of biological treatment per month was 429.9 (SD=160) in the period.
Conclusions: The characteristics of the individuals included in the study are in line with what is expected in the literature for individuals with psoriasis. This sociodemographic characterization of the population using biologics offers an important subsidy for planning the availability of these drugs by the SUS. Although the proportion of individuals using adalimumab was higher, a significant proportion of individuals using secukinumab and ustekinumab at baseline was also observed. These results contrast with guidelines recommendations, as both medications should only be used when adalimumab is contraindicated or fails.
