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Bredemeier M, Ranza R, Kakehasi AM, Ranzolin A, da Silveira IG, Ribeiro ACM, Titton DC, Hayata ALS, Carvalho HMS, Kahlow BS, Fernandes V, Louzada P, Bértolo MB, Duarte ÂLBP, Macieira JC, Miranda JRS, Pinheiro GRC, Teodoro RB, Pinheiro MM, Valim V, Pereira IA, Sauma MFLC, de Castro GRW, da Rocha LF, Studart SAS, Gazzeta MO, da Silveira LG, Lupo CM, Laurindo IMM. Safety of the Methotrexate-leflunomide Combination in Rheumatoid Arthritis: Results of a Multicentric, Registry-based, Cohort Study (BiobadaBrasil). J Rheumatol Suppl 2022; 49:122. [PMID: 34974425 DOI: 10.3899/jrheum.201248.c1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bredemeier M, Ranza R, Kakehasi AM, Ranzolin A, da Silveira IG, Ribeiro ACM, Titton DC, Hayata ALS, Carvalho HMS, Kahlow BS, Fernandes V, Louzada P, Bértolo MB, Duarte ÂLBP, Macieira JC, Miranda JRS, Pinheiro GRC, Teodoro RB, Pinheiro MM, Valim V, Pereira IA, Sauma MFLC, de Castro GRW, da Rocha LF, Studart SAS, Gazzeta MO, da Silveira LG, Lupo CM, Laurindo IMM. Safety of the Methotrexate-leflunomide Combination in Rheumatoid Arthritis: Results of a Multicentric, Registry-based, Cohort Study (BiobadaBrasil). J Rheumatol 2021; 48:1519-1527. [PMID: 33934077 DOI: 10.3899/jrheum.201248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the safety of the methotrexate (MTX)-leflunomide (LEF) combination in rheumatoid arthritis (RA), comparing it with other therapeutic schemes involving conventional synthetic (cs-) and biologic (b-) disease-modifying antirheumatic drugs (DMARDs) or Janus kinase inhibitors (JAKi). METHODS Patients with RA starting a treatment course with a csDMARD (without previous use of bDMARD or JAKi) or their first bDMARD/JAKi were followed up in a registry-based, multicentric cohort study in Brazil (BiobadaBrasil). The primary outcome was the incidence of serious adverse events (SAEs); secondary outcomes included serious infections. Multivariate Cox proportional hazards models and propensity score matching analysis (PSMA) were used for statistical comparisons. RESULTS In total, 1671 patients (5349 patient-years [PY]) were enrolled; 452 patients (1537 PY) received MTX + LEF. The overall incidence of SAEs was 5.6 per 100 PY. The hazard of SAEs for MTX + LEF was not higher than for MTX or LEF (adjusted HR [aHR] 1.00, 95% CI 0.76-1.31, P = 0.98). MTX + LEF presented a lower hazard of SAEs (aHR 0.56, 95% CI 0.36-0.88, P = 0.01) and infectious SAEs (aHR 0.48, 95% CI 0.25-0.94, P = 0.03) than bDMARDs/JAKi with MTX or LEF. MTX + LEF presented lower hazard of SAEs than MTX + sulfasalazine (SSZ; aHR 0.33, 95% CI 0.16-0.65, P = 0.002). Analysis using PSMA confirmed the results obtained with traditional multivariate Cox analysis. CONCLUSION In our study, MTX + LEF presented a relatively good overall safety profile in comparison to MTX + SSZ and schemes involving advanced therapies in RA.
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Affiliation(s)
- Markus Bredemeier
- M. Bredemeier, MD, PhD, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre;
| | - Roberto Ranza
- R. Ranza, MD, PhD, Universidade Federal de Uberlândia, Uberlândia
| | - Adriana M Kakehasi
- A.M. Kakehasi, MD, PhD, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte
| | - Aline Ranzolin
- A. Ranzolin, MD, PhD, A.L. Duarte, MD, PhD, Universidade Federal de Pernambuco (UFPE), Recife
| | - Inês G da Silveira
- I.G. da Silveira, MD, PhD, Hospital São Lucas, Faculdade de Medicina da PUCRS, Porto Algere
| | - Ana C M Ribeiro
- A.C. Ribeiro, MD, PhD, Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP), São Paulo
| | - David C Titton
- D.C. Titton, MD, Universidade Federal do Paraná, Curitiba
| | | | | | - Bárbara S Kahlow
- B.S. Kahlow, MD, Hospital Universitário Evangélico de Curitiba, Curitiba
| | - Vander Fernandes
- V. Fernandes, MD, PhD, Hospital Geral Universitário de Cuiabá, Cuiabá
| | - Paulo Louzada
- P. Louzada Jr., MD, PhD, Faculdade de Medicina USP, Ribeirão Preto
| | - Manoel B Bértolo
- M. Bértolo, MD, PhD, Universidade Estadual de Campinas, Campinas
| | - Ângela L B P Duarte
- A. Ranzolin, MD, PhD, A.L. Duarte, MD, PhD, Universidade Federal de Pernambuco (UFPE), Recife
| | | | - José R S Miranda
- J.R. Miranda, MD, Artrocenter Clínica Médica de Taubaté, Taubaté
| | | | - Reginaldo B Teodoro
- R.B. Teodoro, MD, Hospital da Universidade Federal do Triângulo Mineiro, Uberaba
| | | | - Valéria Valim
- V. Valim, MD, PhD, Universidade Federal do Espírito Santo, Vitória
| | - Ivânio A Pereira
- I.A. Pereira, MD, PhD, Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis
| | | | | | - Laurindo F da Rocha
- L.F. da Rocha Jr., MD, PhD, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife
| | | | - Morgana O Gazzeta
- M.O. Gazzeta, MD, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro
| | - Leticia G da Silveira
- L.G. da Silveira, MS, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre
| | - Cristiano M Lupo
- C.M. Lupo, MD, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto
| | - Ieda M M Laurindo
- I.M. Laurindo, MD, PhD, Faculdade de Medicina da Universidade Nove de Julho, São Paulo, Brazil
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Oude Voshaar MAH, Das Gupta Z, Bijlsma JWJ, Boonen A, Chau J, Courvoisier DS, Curtis JR, Ellis B, Ernestam S, Gossec L, Hale C, Hornjeff J, Leung KYY, Lidar M, Mease P, Michaud K, Mody GM, Ndosi M, Opava CH, Pinheiro GRC, Salt M, Soriano ER, Taylor WJ, Voshaar MJH, Weel AEAM, de Wit M, Wulffraat N, van de Laar MAFJ, Vonkeman HE. International Consortium for Health Outcome Measurement Set of Outcomes That Matter to People Living With Inflammatory Arthritis: Consensus From an International Working Group. Arthritis Care Res (Hoboken) 2020; 71:1556-1565. [PMID: 30358135 PMCID: PMC6900179 DOI: 10.1002/acr.23799] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
Objective The implementation of value‐based health care in inflammatory arthritis requires a standardized set of modifiable outcomes and risk‐adjustment variables that is feasible to implement worldwide. Methods The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary working group that consisted of 24 experts from 6 continents, including 6 patient representatives, to develop a standard set of outcomes for inflammatory arthritis. The process followed a structured approach, using a modified Delphi process to reach consensus on the following decision areas: conditions covered by the set, outcome domains, outcome measures, and risk‐adjustment variables. Consensus in areas 2 to 4 were supported by systematic literature reviews and consultation of experts. Results The ICHOM Inflammatory Arthritis Standard Set covers patients with rheumatoid arthritis (RA), axial spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). We recommend that outcomes regarding pain, fatigue, activity limitations, overall physical and mental health impact, work/school/housework ability and productivity, disease activity, and serious adverse events be collected at least annually. Validated measures for patient‐reported outcomes were endorsed and linked to common reporting metrics. Age, sex at birth, education level, smoking status, comorbidities, time since diagnosis, and rheumatoid factor and anti‐citrullinated protein antibody lab testing for RA and JIA should be collected as risk‐adjustment variables. Conclusion We present the ICHOM inflammatory arthritis Standard Set of outcomes, which enables health care providers to implement the value‐based health care framework and compare outcomes that are important to patients with inflammatory arthritis.
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Affiliation(s)
| | - Zofia Das Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Annelies Boonen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeffrey Chau
- Hong Kong Psoriatic Arthritis Association, Hong Kong, China
| | | | | | | | | | - Laure Gossec
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Katy Y Y Leung
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | | | - Phillip Mease
- Providence St. Joseph Health System, University of Washington, Seattle
| | - Kaleb Michaud
- University of Nebraska Medical Center Omaha, and the National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | | | | | | | - Matthew Salt
- International Consortium for Health Outcomes Measurement, London, UK
| | - Enrique R Soriano
- Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Maarten de Wit
- VU University Medical Centre, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nico Wulffraat
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mart A F J van de Laar
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
| | - Harald E Vonkeman
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
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Cecconi M, Ranza R, Titton DC, Moraes JCB, Bertolo M, Bianchi W, Brenol C, Carvalho HM, de Castro GRW, Costa IP, Cunha MFL, Duarte Â, Fernandes V, Freire M, Louzada-Junior P, Macieira JC, Miranda JRS, Pereira IA, Pinheiro GRC, Stadler B, Toledo RA, Valim V, Descalzo MA, Pinto RMC, Laurindo I. Incidence of Infectious Adverse Events in Patients With Rheumatoid Arthritis and Spondyloarthritis on Biologic Drugs-Data From the Brazilian Registry for Biologics Monitoring. J Clin Rheumatol 2020; 26:73-78. [PMID: 32073519 PMCID: PMC7034387 DOI: 10.1097/rhu.0000000000000935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The safety profile of biologic drugs might present substantial regional differences. Since 2009, the Brazilian Society of Rheumatology has maintained BIOBADABRASIL (Brazilian Registry for Biologic Drugs), a registry for monitoring of biologic therapies in rheumatic diseases. OBJECTIVES The aim of this study was to verify the incidence rate (IR) of serious infections in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients on biologic drugs. METHODS BIOBADABRASIL prospectively included patients with rheumatic diseases who started the first biologic drug or a synthetic disease-modifying antirheumatic drug as a parallel control group. This study focuses on serious infectious adverse events (SIAEs) in RA and SpA patients on biologic drugs compared with controls, from January 2009 to June 2015. Time of exposure was set from initiation of the drug to the date of last administration or censorship. Serious infectious adverse events IR was calculated per 1000 patient/years with 95% confidence interval (CI). RESULTS A total of 1698 patients (RA, 1121; SpA, 577) were included, 7119 patient/years. Serious infectious adverse events were more common among patients on tumor necrosis factor inhibitors (TNFi's) than controls (adjusted IR ratio, 2.96 [95% CI, 2.01-4.36]; p < 0.001). Subsequent TNFi was associated with a higher SIAEs incidence when compared with first TNFI (adjusted IR ratio, 1.55 [95% CI, 1.15-2.08]; p = 0.004). Serious infectious adverse events were associated with age and corticosteroids intake. Serious infectious adverse events were more frequent in the respiratory tract in all subgroups. CONCLUSIONS In BIOBADABRASIL, biologic drugs, especially the subsequent TNFi, were associated with a higher risk of serious infections compared with synthetic DMARDs. Corticosteroid intake and age represented risk factors for SIAEs. Constant monitoring is required to follow the safety profile of drugs in the clinical setting of rheumatic conditions in Brazil.
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Affiliation(s)
| | - Roberto Ranza
- From the Universidade Federal de Uberlândia, Uberlândia
| | | | | | | | | | - Claiton Brenol
- Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto A. Toledo
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto
| | | | | | | | - Ieda Laurindo
- Faculdade de Medicina da Universidade Nove de Julho, São Paulo, Brazil
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Gomides APM, Albuquerque CP, Santos ABV, Amorim RBC, Bértolo MB, Júnior PL, Santos IA, Giorgi RD, Sacilotto NC, Radominski SC, Borghi FM, Guimarães MFBR, Pinto MRC, Resende GG, Bonfiglioli KR, Carriço H, Sauma MFLC, Sauma ML, Medeiros JB, Pereira IA, Castro GRW, Brenol CV, Xavier RM, Mota LMH, Pinheiro GRC. High Levels of Polypharmacy in Rheumatoid Arthritis-A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study. J Pharm Pract 2019; 34:365-371. [PMID: 31451091 DOI: 10.1177/0897190019869158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. OBJECTIVE To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. METHODS A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. RESULTS We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). CONCLUSION We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.
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Affiliation(s)
| | | | - Ana B V Santos
- 28130Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Paulo L Júnior
- Faculdade de Medicina da Universidade de Ribeirao Preto, 28133Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Isabela A Santos
- Faculdade de Medicina da Universidade de Ribeirao Preto, 28133Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Rina D Giorgi
- 74357Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Nathália C Sacilotto
- 74357Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | | | - Maria R C Pinto
- 28114Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | - Ivânio A Pereira
- 28117Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Gláucio R W Castro
- 28131Universidade do Sul de Santa Catarina-Unisul, Florianópolis, Brazil
| | - Claiton V Brenol
- 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo M Xavier
- 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Batista NV, Barbagallo M, Oliveira VLS, Castro-Gomes T, Oliveira RDR, Louzada-Junior P, Pinheiro GRC, Mantovani A, Teixeira MM, Garlanda C, Amaral FA. The Long Pentraxin 3 Contributes to Joint Inflammation in Gout by Facilitating the Phagocytosis of Monosodium Urate Crystals. J Immunol 2019; 202:1807-1814. [PMID: 30718300 DOI: 10.4049/jimmunol.1701531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/04/2019] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to investigate the role of pentraxin 3 (PTX3), a pivotal component of the innate immune system, in gout. Levels of PTX3 and IL-1β in human samples were evaluated by ELISA. Development of murine gout was evaluated through the levels of cytokines (PTX3, CXCL1, and IL-1β) and neutrophil recruitment into the joint cavity. Phagocytosis of monosodium urate (MSU) crystals and caspase-1 activation were determined by flow cytometer. Acute gout patients showed elevated concentration of PTX3 in plasma and synovial fluid as compared with healthy and osteoarthritic subjects. Moreover, there was a positive correlation between intra-articular PTX3 and IL-1β levels. PTX3 was induced in the periarticular tissue of mice postinjection of MSU crystals. Importantly, Ptx3-deficient mice showed reduced inflammation in response to MSU crystal injection compared with wild-type mice, including reduction of neutrophil recruitment into the joint cavity and IL-1β and CXCL1 production. Interestingly, addition of PTX3 in vitro enhanced MSU crystal phagocytosis by monocytes and resulted in higher production of IL-1β by macrophages. This contribution of PTX3 to the phagocytosis of MSU crystals and consequent production of IL-1β occurred through a mechanism mainly dependent on FcγRIII. Thus, our results suggest that PTX3 acts as a humoral pattern recognition molecule in gout facilitating MSU crystal phagocytosis and contributing to the pathogenesis of gouty arthritis.
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Affiliation(s)
- Nathália V Batista
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | | | - Vivian L S Oliveira
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Thiago Castro-Gomes
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Rene D R Oliveira
- Division of Rheumatology, Ribeirão Preto Medical School, University of São Paulo, São Paulo 1409-900, Brazil
| | - Paulo Louzada-Junior
- Division of Rheumatology, Ribeirão Preto Medical School, University of São Paulo, São Paulo 1409-900, Brazil
| | - Geraldo R C Pinheiro
- Discipline of Rheumatology, University of State of Rio de Janeiro, Rio de Janeiro 20550-900, Brazil
| | - Alberto Mantovani
- Humanitas University, Pieve Emanuele 20090, Italy; and.,The William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Mauro M Teixeira
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Cecilia Garlanda
- Humanitas Research Hospital, Rozzano 20089, Italy; .,Humanitas University, Pieve Emanuele 20090, Italy; and
| | - Flávio A Amaral
- Laboratory of Immunopharmacology, Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
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Fafá BP, Louzada-Junior P, Titton DC, Zandonade E, Ranza R, Laurindo I, Peçanha P, Ranzolin A, Hayata AL, Duarte A, Silveira IG, Costa I, Macieira JC, Guedes-Barbosa LS, Bertolo MB, Sauma MFLDC, Silva MBG, Freire M, Scheinberg MA, Fernandes V, Bianchi W, Miranda JRS, Pinheiro GRC, Carvalho HMS, Brenol CV, Pereira IA, de Castro GRW, de Morais JCB, Oliveira SKF, de Abreu MM, Toledo RA, Pinheiro MM, Vieira WP, Valim V. Drug survival and causes of discontinuation of the first anti-TNF in ankylosing spondylitis compared with rheumatoid arthritis: analysis from BIOBADABRASIL. Clin Rheumatol 2015; 34:921-7. [PMID: 25851594 DOI: 10.1007/s10067-015-2929-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 12/19/2022]
Abstract
Treatment survival with biological therapy may be influenced by many factors, and it seems to be different among various rheumatic diseases and biological agents. The goal of the study was to compare the drug survival and the causes of discontinuation of anti-tumoral necrosis factor (anti-TNF) therapy in ankylosing spondylitis (AS) with rheumatoid arthritis (RA). Study participants were a cohort from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (BIOBADABRASIL) between 2008 and 2012. The observation time was up to 4 years following the introduction of the first treatment. Gender, age, disease duration, disease activity, comorbidities, and concomitant therapies were assessed. A total of 1303 patients were included: 372 had AS and 931 had RA in which 38.7 % (n = 504) used infliximab (IFX), 34.9 % (n = 455) used adalimumab (ADA), and 26.4 % (n = 344) used etanercept (ETA). The anti-TNF drug survival of patients with AS was 63.08 months (confidence interval (CI) 60.24, 65.92) and patients with RA was 47.5 months (CI 45.65, 49.36). It was significant higher in AS (log-rank; p ≤ 0.001). Patients with RA discontinued anti-TNF more than patients with AS when adjusted to gender and corticosteroid. The adjHR (95 % CI) was 1.6 (1.14, 2.31). Female patients who were also corticosteroid users, but not of advanced age, have shown lower survival for both diseases (log-rank, p ≤ 0.001). The discontinuation rate of IFX, but not of ADA or ETA, was significantly higher in RA than in SA; HR (95 % CI) was 2.49 (1.46, 4.24). The main causes of discontinuation were ineffectiveness and adverse event in both diseases. AS patients have better drug survival adjusted to gender, age, and corticosteroid. This results appear to be related to the disease mechanism.
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Affiliation(s)
- Bárbara P Fafá
- Rheumatology Division, University Hospital Cassiano Antônio de Moraes, Medicine Department, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1460, Departamento de Clínica Médica, CEP 29040-090, Vitória, Espírito Santo, Brazil
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8
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Nardi EP, Ferraz MB, Pinheiro GRC, Kowalski SC, Sato EI. Perceptions of the population regarding generic drugs in Brazil: a nationwide survey. BMC Public Health 2015; 15:117. [PMID: 25881315 PMCID: PMC4334599 DOI: 10.1186/s12889-015-1475-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/27/2015] [Indexed: 11/15/2022] Open
Abstract
Background Generic drugs (GDs) offer a way to reduce health spending without sacrificing quality. Despite this, there are doubts as to their acceptance by the population. This work aims to assess perceptions of GDs among the Brazilian population. Methods We conducted a national household survey face-to-face between April and May 2013, with 5000 individuals aged over 15 years. The questions explored socioeconomic and demographic characteristics, the use of GDs, and perceptions about GDs as compared to brand drugs (BDs). The chi-square test was used to examine the associations between the perceptions and the characteristics of the population. Results Of the 5000 participants, 51.3% were women, 40.2% were white, 48.6% were between 15 and 34 years of age, and 52.3% had income of less than two minimum wages (US$627.78). In terms of the use of GDs, 44.6% of the participants were taking or had taken GDs in the past three months, with the highest figures among the elderly (61.1%) and female (49.2%) populations. Regarding perceptions, 30.4% of the respondents considered GDs less effective than BDs; provided the same price, 59% would prefer BD, and 45.8% agreed that physicians prefer to prescribe GDs. The most negative perceptions about GDs were observed among lower income, elderly and nonwhite populations. Conclusion The findings provide a better understanding of Brazilians’ perceptions regarding GDs. This should be considered when formulating healthcare policies aiming at improving access to effective and quality drugs, and reduction of health costs.
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Affiliation(s)
- Elene P Nardi
- São Paulo Center for Health Economics (GRIDES), Universidade Federal de São Paulo, Rua Botucatu 740, São Paulo, CEP- 04023-062, Brasil.
| | - Marcos B Ferraz
- São Paulo Center for Health Economics (GRIDES), Universidade Federal de São Paulo, Rua Botucatu 740, São Paulo, CEP- 04023-062, Brasil.
| | - Geraldo R C Pinheiro
- Department of Internal Medicine, Discipline of Rheumatology, Universidade do Estado do Rio de Janeiro, Av 28 de Setembro, 77 - sala 333, Vila Isabel, CEP 20551-030, Rio de Janeiro, Brasil.
| | - Sérgio C Kowalski
- Department of Clinical Epidemiology and Biostatistics, Mc Master University, 1280 Main St West, Office HSC 2C20, L8S 4K1, Hamilton, Ontario, Canada.
| | - Emilia I Sato
- Department of Medicine, Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu 740, CEP- 04023-062, São Paulo, Brasil.
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9
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Laurindo IMM, Ximenes AC, Lima FAC, Pinheiro GRC, Batistella LR, Bertolo MB, Alencar P, Xavier RM, Giorgi RDN, Ciconelli RM, Radominski SC. Artrite reumatóide: diagnóstico e tratamento. Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000600007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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