Efetividade clínica dos medicamentos biológicos anti-TNF, biológicos não anti-TNF e sintético alvo-específico no tratamento da artrite reumatoide.

Abstract

Introduction: Rheumatoid Arthritis is a systemic, chronical inflammatory disease associated to peripheral polyarthritis, which leads to deformity and destruction of joints due to erosion of cartilage and bone. Treatment must be initiated as soon as possible, considering that the drug therapy, when instituted early, prevent structural damage, improving the patient’s functional capacity. Objective: Evaluate the clinical effectiveness of disease-modifying antirheumatic drugs (DMARDs) biological antiTNF, biological non-anti-TNF and synthetic target-specific in patients attended by the Public System of Health in Minas Gerais in the treatment of rheumatoid arthritis. Methodology: this is an open concurrent cohort, performed from March 2011 to August 2021. Patients older than 18 years of age, diagnosed with rheumatoid arthritis with administrative processes for requesting medications approved by the Regional Health Superintendence of Belo Horizonte were included to perform the treatment with DMARDs biological anti-TNF (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), DMARDs biological non-anti-TNF (abatacept, rituximab, tocilizumab) or specific target synthetic DMARD (tofacitinib). The patients were accompanied for six months through interviews to measure effectiveness, safety, quality of life and functionality. The first interview occurred at the beginning of treatment and data on the sociodemographic and clinical characteristics of the patients were collected. Disease activity was measured by the Clinical Disease Activity Index (CDAI), patients' functional capacity was measured by the Health Questionnaire Assessment Disability Index (HAQ-DI) and quality of life by the EuroQol Five Dimensions (EQ-5D) and visual analogic scale (VAS). The measure of effectiveness was defined from the scope of remission or mild activity of the disease by the CDAI. Results: A total of 657 patients participated in the study. Of these, 492 (74.9) used a DMARD biological anti-TNF drug, 105 (16.0) used a non-anti-TNF biological and 60 (9.1) of the patients used DMARD synthetic target specific. Of the 657 research participants, 253 (38.5) achieved remission or mild activity disease and 404 (61.5) remained in moderate to high activity. In the analysis of the baseline characteristics predicting effectiveness response in six months, it was found that the effectiveness of the drugs was better in patients who were using conventional synthetic DMARDs, in those patients who presented a better functionality (HAQ) and quality of life (EQ-5D), and the use of DMARD biological anti-TNF when compared to DMARD biological non-anti-TNF. In the safety analysis, the main adverse events reported by the patients were: alopecia 121 (18.4), reaction at the application site 104 (15.8), and headache 100 (15.2). Conclusion: bDMARDs anti-TNF, bDMARDs nonanti-TNF and tsDMARD were able to reduce disease activity, improve functionality and quality of life in RA patients. However, it was possible to observe that the percentage of patients who reached the therapeutic goal of remission or low disease activity was 38.5%. Furthermore, in the analysis of the proportion of patients who achieved treatment effectiveness at six months of follow-up, a statistically between the groups that used an bDMARDs anti-TNF and bDMARDs non-anti-TNF.