Avaliação da efetividade e segurança dos agentes Anti-TNF utilizados no tratamento de pacientes com Artrite Reumatoide em Minas Gerais

Abstract

Rheumatoid arthritis (RA) is an inflammatory, systemic and progressive disease that leads to deformity and destruction of joints. RA needs treatment for a long time resulting in high costs for the Brazilian Unified Health System (Sistema Único de Saúde - SUS). Pharmacological treatment includes the use of biological agents, such as anti-TNF, which are indicated for patients who have failed treatment with therapeutic disease-modifying anti-rheumatic drugs (DMARDs). The aim of this study was to evaluate the effectiveness and safety of anti-TNF agents, used in the treatment of rheumatoid arthritis provided by SUS through Regional Health Superintendence of Belo Horizonte, Minas Gerais. Patients were followed by 18 months. Interviews in the first dispensation of the medication and then every six months were conducted. The cohort consisted of 51 patients with RA, mostly female with the average time of disease duration of 10.11 years. Around 65% of patients (n= 33) began the study taking adalimumab, 19.6% (n= 10) took etanercept, 13.7% (n= 7) golimumab, and 2.0% (n= 1) certolizumab. The Clinical Disease Activity Index (CDAI) showed an average value of 25.03, indicating high disease activity at the baseline. There was a statistically significant difference between the average value of CDAI presented in the first interview when compared to the value of the second, third and fourth interview. However, the same was not found when comparing CDAI from second to third, and from third to fourth interview. It was found that only 52.9%, 51.0%, 52.9% of patients achieved remission or mild activity of RA after six, 12 and 18 months of treatment, respectively. At 6 months of follow-up after treatment, 74.5% (n= 38) of patients reported some type of adverse reaction, 60.8% (n= 31) after 12 months and 62.7% (n= 32) after 18 months. Overall, treatment with anti-TNF has been well tolerated by patients in this cohort. The results of this study reinforce the importance of continuous monitoring of patients to verify the possibility of exchange of therapy in treatment failure situations and / or adverse reactions, to ensure a better quality of life for patients and avoid unnecessary expense by SUS.