Adesão e persistência ao tratamento com agentes biológicos fornecidos pelo Sistema Único de Saúde para doenças reumáticas em Minas Gerais.

Abstract

The aim of this study was to measure nonadherence and nonpersistence to biological therapy in patients with rheumatic diseases treated in the National Health System in Minas Gerais State, as well as factors associated with these events. This was a non-concurrent cohort study from administrative databases (pharmacy records). Cohort was composed of 3 patients groups: rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) who had newly initiated adalimumab or etanercept in 2011. Patient nonadherence and nonpersistence were assessed during 1 year after the first dispensing. Non-adherence was assessed by measuring the proportion of days covered (PDC), and considered nonadherent patients if PDC<0.8. The nonpersistence was presented dichotomously based on intervals and in curve describing the persistence level in a time period. Multivariate logistic regression was used to assess dichotomous outcomes and drug survival analyses to estimate persistence. A total of 1174 patients who had newly initiated adalimumab or etanercept in 2011 were included. Of the total patients, 64.6 % were diagnosed with RA, 8,4% PsA and 27.0% AS and all groups had median age of 49 years. RA patients were older and a larger proportion of RA patients were women More than half of patients with AS were male. Adalimumab was prescribed more often. During follow-up, 34% of patients were nonadherent and 21.2% nonpersistent. Factors such as younger age (19-39 years compared to 50-58 years), female gender, diagnosis of RA, early treatment with etanercept and switching of medication were associated to poor medication adherence. Female sex was significant predictor of nonpersistence. Although important, the nonadherence and nonpersistence factors might have limitations since there was no clinical evaluation associated with them. During this study course, only 2% of the patients switched medications. Of nonpersistent patients, 27.4% restarted the therapy after stopped for 60 days. Nonadherence rate was similar to results from another countries. On the other hand, nonpersistency was lower suggesting that adherence could be improved. A better patient pharmacotherapy follow-up could improve the quality of drug use, as well as help to identify adverse effects related to biological therapy. Putting together, understanding the factors associated with nonadherence and nonpersistence in rheumatic diseases treatment are a first step to efficient interventions and will contribute to increase treatment continuation, improve adherence behavior and reduce inadequate drug intervention.