| dc.description.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. | |
