Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations

Silva, Michael Ruberson Ribeiro da; Santos, Jéssica Barreto Ribeiro dos; Almeida, Alessandra Maciel; Júnior, Augusto Afonso Guerra; Álvares-Teodoro, Juliana; Acúrcio, Francisco de Assis

doi:10.1080/1744666x.2019.1631798

Cited by 16 publications

(29 citation statements)

References 39 publications

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“…It is an important finding once medication persistence has been used as a proxy of effectiveness and safety for biological therapies applied to rheumatic diseases. 18,34,35 Intravenous administration route and lower BASDAI were identified as associated factors to medication adherence and persistence. Bolge et al (2017) reported that patients using intravenous biologics are highly satisfied with their medications and perceive the opportunity for health care provider interaction at their infusion facilities as an advantage of their regimen.…”

Section: Discussionmentioning

confidence: 99%

“…17 Also, these drugs are expensive and correspond to 90% of the total cost of PsA treatment. 18 Currently, there are five approved anti-TNFs: (1) infliximab, a chimeric IgG anti-human monoclonal; (2) etanercept, a TNFR2 dimeric fusion protein, with an IgG1 Fc; (3) adalimumab, a fully human monoclonal antibody (mAb); (4) golimumab, also a fully human mAb and (5) certolizumab, a PEGylated Fab fragment. Infliximab is available in intravenous infusion and shall be administered in an adequate place like a hospital or a specialty clinic in biological infusion, while other anti-TNFs are available as subcutaneous injections and can be self-administered.…”

Section: 3mentioning

confidence: 99%

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Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

Souza¹,

Silva²,

Santos³

et al. 2021

Pharm Pract (Granada)

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Background: Pharmaceutical services in Brazil provide access, supply, and rational use of drugs for all population and an effort has been made to improve the quality of these services. Biological drugs are high-cost drugs supplied in Brazil that can inhibit disease progression and improve the quality of life of psoriatic arthritis (PsA) patients. However, some patients did not achieve therapeutic goals. Objective: To evaluate the medication adherence and persistence of PsA patients treated with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated factors. Methods: A prospective observational study was performed at a single-specialty pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and clinical outcomes were evaluated at 12 months of follow-up. Medication persistence was historically compared to overall PsA patients treated in Brazil. Associated factors were identified through log-binomial regression. Results: One hundred ninety-seven PsA patients were included in the study, of whom 147 (74.6%) and 142 (72.1%) had medication adherence and persistence, respectively. Patients treated with infliximab presented the highest adherence (90.5%) and persistence rate (95.2%) in comparison to patients treated with other drugs, except for adalimumab versus infliximab for adherence outcome. All clinical measures significantly improved in patients with medication adherence and persistence. Medication persistence was higher for patients attended by specialty pharmacy than other PsA patients in Brazil. The associated factors to higher medication adherence were lower disease activity by BASDAI, being non-white race, and intravenous drug use. The associated factors to higher medication persistence were lower disease activity by Bath Ankylosing Spondylitis Activity Index (BASDAI), intravenous drug use, non-use of corticoids and non-steroidal anti-inflammatory drugs, and comorbidity. Conclusions: Patients with medication adherence and persistence had significant improvements in clinical measures, functionality, and quality of life. High medication adherence and persistence to biological therapy were observed and associated with lesser disease activity at baseline. Also, medication persistence to PsA patients attended in specialty pharmacy was higher than the overall PsA population in Brazil, which indicates the importance of pharmaceutical services to provide health care and promote the effectiveness and safety of biological therapies.

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Section: Discussionmentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

Souza¹,

Silva²,

Santos³

et al. 2021

Pharm Pract (Granada)

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“…This is a similar situation in Europe where accessing expensive drugs is not easy due to the economic welfare of a country, even though the drugs have been shown to have much more efficacy with regard to suppressing inflammatory diseases 26 . However, there has been a considerable price reduction recently observed for anti-TNF agents over the past few years 17 . Furthermore, it is expected that there will be easier economic access to IFX for the treatment of BS in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, IFX is generally given to BS patients after failed treatments with these other drugs. Furthermore, due to the huge financial burden for BS patients who need to regularly use IFX [15][16][17] , it has been estimated that worldwide, IFX is administered after encountering the ineffectiveness of these other conventional anti-inflammatory agents.…”

mentioning

confidence: 99%

A 10-year follow-up of infliximab monotherapy for refractory uveitis in Behçet’s syndrome

Horiguchi

Kamoi

Horie

et al. 2020

Sci Rep

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Infliximab (IFX) was the first biologic introduced for refractory uveitis treatment in Behçet’s syndrome (BS). However, there have been few reports on the safety and efficacy of IFX monotherapy over follow-up periods of more than 10 years. This retrospective study evaluated the 10-year safety and efficacy of IFX monotherapy compared to IFX combination therapies with colchicine or corticosteroid for refractory uveitis in BS patients. Monotherapy was performed in 30 eyes of 16 patients while combination therapies were performed in 20 eyes of 11 patients. Continuation of IFX occurred in 70.3% of enrolled patients for 10 years without any significant difference noted in the retention rate between the monotherapy and combination therapies (p = 0.86). Reduction of ocular inflammatory attacks and improvement of best corrected visual acuity occurred in the monotherapy group after 10 years, which was equivalent to that for the combination therapies. Although adverse events (AEs) or therapy discontinuation occurred during the initial 5 years in both therapies, no AEs were observed for either therapy after 6 years. Our results suggested that IFX monotherapy proved to be effective and not inferior to combination therapies over a 10-year follow-up. Although loss of response and AEs may be noticed during the initial 5-year period, a safe and effective continuation can be expected thereafter.

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“…This is particularly important given the cost of these new therapies. The amount spent with anti-TNF agents for the treatment of patients with PsA in the SUS between 2010 and 2015 was approximately US$ 300 million (dollar adjusted by purchasing power parity), corresponding to 90% of the total costs with PsA [7].…”

Section: Introductionmentioning

confidence: 99%

Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

et al. 2019

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Background: Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. Methods: A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. Results: A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44-90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. Conclusion: The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

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Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations

Cited by 16 publications

References 39 publications

Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

A 10-year follow-up of infliximab monotherapy for refractory uveitis in Behçet’s syndrome

Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

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