BACKGROUNDPatients with autoimmune diseases, for the most part, need continuous or prolonged use of immunosuppressive drugs. In the midst of the therapeutic arsenal, the use of the subcutaneous (SC) route has been an important treatment option for such patients. The objective of this study was to evaluate the perception of patients regarding the use of immunosuppressive drugs administered via the SC route. METHODSAn observational, cross-sectional study was carried out with the application of a questionnaire to patients over 18 years of age, followed up at the rheumatology center in a tertiary hospital, users of at least two doses of immunosuppressive medication administered subcutaneously. RESULTSA total of 123 patients were interviewed, most of them with rheumatoid arthritis (76%) and spondyloarthropathy (19%), of female gender (84%), with a mean age of 66 years. Medication at home was taken for 76% of the patients, and in 68% of the cases the application was done by the patient, with 27% reporting some difficulty at the time of application and 30% preferring to modify it to perform it in a supervised way. However, only 14% of them reported some degree of insecurity in performing it at home; 24% of the patients apply the medication in some health establishment, being 50% in the basic health units and 50% in the infusion center of the hospital; 85% of respondents stored the medication correctly, but 12% reported recurrent lack of light in their home. Of the patients who took their medication at home, 18% reported delays in taking the medication versus 13% of the group who attended a health facility. CONCLUSIONThe use of SC immunosuppressive drugs has been used for a long time in autoimmune diseases and an adequate explanation about the care with the medication, as well as its application, in addition to the patients' understanding of their own condition, are factors that favor adherence to the medication. treatment and, therefore, better outcomes.

BACKGROUNDOsteoporosis (OP) is the most prevalent skeletal disease and can increase the risk of fracture. Within the pharmacological arsenal available for the control of OP, there are some options for subcutaneous (SC) use, such as denosumab (DNS), teriparatide (TER) and romosozumab (ROM). Adherence and persistence to treatment with SC use are influenced by age, cognition, needle anxiety, fear of losing medication and availability of a caregiver. The aim of this study was to evaluate the profile of patients using SC medication for OP and some factors that can impair the success of the treatment. METHODSAn observational, cross-sectional study was carried out through the application of a questionnaire to patients diagnosed with osteoporosis and using DNS and TER, followed up at the rheumatology's center of a tertiary hospital. RESULTForty-two patients were interviewed, 64% using DNS and 36% using ER, 95% being female, with an average age of 76.97 years. As expected, in TER (daily use medication), 100% were administered at home and only 13% of cases reported difficulty in application. In DNS (semestral medication), on the contrary, 74% of patients preferred application in a health unit (HU) for convenience or guidance from the medical team. In home cases (TER+DNS), 59% were applied by a caregiver and 41% were self-administered (p = 0.05). No statistical difference was found in relation to the delay in medication application among patients who used it at home or in a health unit (p = 0.59). The vast majority (90%) knew the correct way to store the medication in the refrigerator and 95% did not consider instability in the electrical network as a problem. CONCLUSIONThe choice of a SC medication must undergo a careful analysis of factors such as the convenience of choosing the place for application (home X HU), availability of a support individual (caregiver), in addition to intensive education of the patient and family regarding the various aspects of the chosen drug.

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BACKGROUNDSecukinumab (SEC) is a human monoclonal antibody that inhibits IL-17A. It is effective in controlling signs/symptoms of psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (SpA), in refractory patients, in those who had adverse effects to immunobiologicals and also in those naïve to immunobiological drugs. The aim of this study is to evaluate clinical and epidemiological characteristics of patients using SEC, with follow-up in psoriasis and spondyloarthritis clinics in a tertiary hospital. METHODSRetrospective medical record review study, including 37 patients who met classification criteria for PsO, PsA and SpA, and used at least five SEC injections (induction dose) between 01/2017 and 06/2021, in a tertiary hospital. RESULTSThirty-seven patients were divided into two groups: 23 with PsO (8) or PsA (15) (group 1) and 14 with SpA (group 2). Sixty-five percent of group 1 patients were female. The mean age was 55.3 years old and average time of diagnosis was 8.5 years; 66.7% of PsA patients had isolated arthritis, 13% enthesitis and 7% isolated dactylitis; 53% of the patients showed axial symptoms in association with peripheral harm; 4% of patients had history of uveitis and 9% inflammatory bowel disease (IBD). Secukinumab was indicated by active disease in 74% of the patients and suspended for secondary failure in 9% of the cases. Average treatment time was 22 months (standard deviation, SD = 13.71). Of group 2, 57% of patients were male. The mean age was 46.9 years old and average time of diagnosis was 12.1 years; 14% of the cases had arthritis, 14% enthesitis and 14% arthritis plus enthesitis, beyond axial disease; 36% of the patients had uveitis and 7% IBD in their medical records. Secukinumab was indicated by active disease in 86% of the patients and suspended for secondary failure in 14% of the cases. Average treatment time was 24 months (SD = 11.32). One patient had fungal vulvovaginitis, without the need to interrupt medication. There were not flares or reactivation of uveitis or IBD. There was statistically significant difference regarding the initial presence of uveitis in group 2 (36% vs. 4%, p = 0.02) and older ages in group 1 (55.3 vs. 46.9, p = 0.039). CONCLUSIONIn the studied patients, similar characteristics were observed regarding demographic data, indication, time of use and discontinuation rates of SEC. In this real-life study, the medication was shown to be safe and effective, as well as in large clinical trials.