Objective To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease.Methods We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center.Results Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage.Conclusion Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.

O objetivo do trabalho foi identificar os medicamentos sujeitos a controle especial mais utilizados em Centros de Atenção Psicossocial (CAPS) no município de Curitiba, Paraná-BR. Estudo retrospectivo, por meio de pesquisa documental em Livros de Registro Específico de medicamentos controlados dos CAPS, referente aos anos de  2013 a 2016. Constatou-se a saída de 10.897 medicamentos, sendo as dispensações para uso emergencial. Foi considerada a denominação comum brasileira (DCB), a forma farmacêutica e as concentrações que eram dispensadas das seguintes classes terapêuticas: antidepressivos, ansiolíticos, antiepiléticos, antipsicóticos, anticolinérgicos e hipnóticos/sedativos. Os mais utilizados foram os antipsicóticos, em específico o Cloridrato de Clorpromazina em comprimido de 100mg (23,41%) e 25mg (18,54%), seguido do ansiolítico Diazepam em comprimido de 5mg (11,86%). O padrão de consumo de psicotrópicos aqui identificados não diferem muito dos estudos semelhantes em outras regiões do Brasil, além de evidenciar o consumo em caráter emergencial de algumas classes terapêuticas.

Objective: Gaucher disease (GD) is a rare disorder linked to the absence/deficiency of glucocerebrosidase. GD can be treated by enzyme replacement therapy (ERT) and substrate reduction therapy (SRT). The aim of this systematic review (SR) is to assess the effectiveness of drugs used for GD treatment. Data Sources: Searches were conducted in PubMed and Scopus, in April 2021. The search strategies encompassed the name of the disease and of the drug treatments. Manual search was also conducted. Study Selection and Data Extraction: Observational and interventional longitudinal studies evaluating ERT and SRT for GD were included. Single mean meta-analyses were conducted for each drug using R. Data Synthesis: The initial search retrieved 2246 articles after duplicates were removed. Following screening and eligibility assessment, 68 reports were included. The studies evaluated imiglucerase, velaglucerase alfa, taliglucerase alfa, miglustat, and eliglustat. The results showed that ERT is effective as a treatment in both naïve and experienced patients. Miglustat did not significantly improve blood outcomes in naïve patients and resulted in a decrease in the platelet levels of experienced patients. Eliglustat was mainly assessed for experienced patients and resulted in stable outcome values. Relevance to Patient Care and Clinical Practice: This extensive SR confirms the effectiveness of GD treatments in short- and long-term follow-ups. Conclusions: The results were favorable for all ERTs and for eliglustat. Based on the assessed evidence, miglustat did not achieved expressive results. However, all evidence should be interpreted considering its limitations and does not replace well-conducted randomized trials.

O estudo objetivou caracterizar as ações de demanda judicial impetradas no estado do Paraná para obtenção do medicamento Brometo de Tiotrópio, destinado ao tratamento de pessoas diagnosticadas com a Doença Pulmonar Obstrutiva Crônica (DPOC). Foram consideradas as ações do período de 2013 a 2016. As variáveis de interesse foram sexo, idade e ocupação dos pacientes, histórico de tabagismo, estágio da DPOC, tratamento e justificativa médica. Nas ações individuais (n=98) predominaram idosos de ambos os sexos (50%), tabagistas ou ex-tabagistas (54%), aposentados (63,3%), com a DPOC grave e muito grave (93,9%). A demanda se justificava pela necessidade de melhorar a resposta clínica (66,3%). O Brometo de Tiotrópio foi recentemente reavaliado e recomendado para incorporação pelo Sistema Único de Saúde (SUS), em razão das novas evidências sobre a sua efetividade e segurança.  A disponibilização deste medicamento pelo SUS traz a perspectiva de maior facilidade no acesso e benefícios terapêuticos para os usuários com DPOC.

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