Rheumatoid artrhitis treatment in Brazil: data from a large real-life multicenter study

Abstract

Background: Last decades witnessed great technological advances in rheumatoid arthritis (RA) management, but their implementation in clinical practice might prove difficult. Despite the efficacy demonstrated in controlled trials this information needs to be confirmed by real life data. This study assessed real-life treatment among RA patients. Methods: REAL study included Brazilian RA patients from eleven centers. Interview and medical records were performed. Continuous variables were compared using Student's t or Mann-Whitney and categorical variables were assessed with chi-square or Fisher's exact tests. Results: 1115 patients were included, women 89.5%. Median age 56.6 years, disease duration 152.5 months; 78.7% were rheumatoid fator positive; 55.2% had erosive disease; DAS28 (disease activity index-28 joints) = 3.5, HAQ (health assessment questionnaire) =0.875. The median duration of symptoms until the start of first DMARD was 12 months. A total of 529 (47.2%) patients used corticosteroids; 1022 (90.8%) were on conventional synthetic (cs) DMARDs and 406 (36.1%) on biological (b) DMARDs. Methotrexate (MTX) was the most frequent csDMARD: 748 (66.5%) patients, followed by leflunomide (LFN), used by 381 (33.9%) of patients. MTX was associated to LFN in 142 (12.6%) patients. Only five (0.4%) patients used triple therapy (MTX + hydroxychloroquine + sulfasalazine) or sulfasalazine in monotherapy. Conclusions: Despite advances in therapeutic resources, roughly half RA patients failed achieve T2T goals and 55.2% developed erosive disease. The frequent use of corticosteroids and delay in initiating DMARDs were demonstrated. Issues concerning timely access to medical care are crucial for effective management.

Real-world treatment patterns of rheumatoid arthritis in Brazil: analysis of DATASUS national administrative claims data for pharmacoepidemiology studies (2010–2020)

“…The study cohort had a median age of 55 years, mostly female (82.8%), and white (57.7%). The characteristics of our cohort corroborated findings from earlier studies in Brazil 14 , 22 , 28 , 29 . Results from the REAL study (2020) of 1115 patients with RA treated at 11 public (SUS) centers across Brazil reported a median age of 56.6 years, 89.5% female, and 58.6% white 29 .…”

Predictors of Remission and Low Disease Activity in Rheumatoid Arthritis Patients

“…Our remission rates were low in comparison to other real-world cohorts of similar baseline sociodemographic and clinical features as described by Yu and colleagues 10 . These differences are even larger when compared with data from early forms of the disease and for cohorts under the T2T strategy 17–21 . Furthermore, the increase in the remission rates over time that we observed is still considered quite inadequate 10,22–25 .…”

“…10 These differences are even larger when compared with data from early forms of the disease and for cohorts under the T2T strategy. [17][18][19][20][21] Furthermore, the increase in the remission rates over time that we observed is still considered quite inadequate. 10,[22][23][24][25] Explanations that come to mind include our patient's low accessibility to b/ts-DMARDs, their relative long disease duration, 26 and/or a delay in the implementation of an adequate tight control strategy.…”

Comparison of rheumatoid arthritis composite disease activity indices and residual activity in a Brazilian multicenter study- REAL study

“…These variables were listed in the descriptive statistical analysis. Other variables and clinical data were detailed in separate articles [23,[26][27][28][29].…”