First line of biological drugs in rheumatoid arthritis: a medication persistence analysis

ABSTRACT

Objectives: To evaluate the persistence of biological drugs used as the first line of biological treatment in patients diagnosed with rheumatoid arthritis. The predictors associated with persistence have also been verified.

Methods: We evaluated a historical cohort composed of users of the Brazilian National Health System in the period between 2006 January and 2014 December. The endpoint was the medication persistence at 12 months.

Results: A population composed of 66,787 individuals started the first line of biological drug. Out of such individuals, 34,595 (51.80%) persisted in the treatment at 12 months. Abatacept was the drug that presented higher persistence, followed by golimumab, tocilizumab, etanercept, and adalimumab and, with lower persistence certolizumab and infliximab. Younger individuals, living in regions with higher social inequality by Gini coefficient, using certolizumab and infliximab in comparison with adalimumab presented a higher risk of non-persistence to treatment. Individuals from the Southeastern region were more persistent than Northeastern, Central-western, Northern and Southern regions.

Conclusion: The medication persistence was different between biological drugs. The rigorous follow-up of patients, by a multidisciplinary team, is important to enable the development of strategies for the adequate use of such drugs.

KEYWORDS:

• Biological drugs
• cohort study
• medication persistence
• public health
• rheumatoid arthritis

Acknowledgments

The authors thank the institutional support of the Collaborating Center of SUS: Technology Assessment and Excellence in Health. dos Santos JBR and da Silva MRR thank the Coordination of Improvement of Higher Education Personnel for granting doctoral scholarships.

Declaration of interest

JBR dos Santos received a PhD fellowship from the Coordination of Improvement of Higher Education Personnel of the Brazilian Ministry of Education. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

dos Santos JBR analyzed the data and wrote the manuscript; Guerra Junior AA and Acurcio FA designed the study and revised the manuscript; da Silva MRR and Alvares-Teodoro J analyzed the data and revised the manuscript; Almeida AM revised the manuscript. All authors agree to be accountable for all aspects of the work.

Additional information

Funding

This paper was not funded.