Background The province of Tucuman is located northwest of Argentina and has a population of 1,448,716 inhabitants, according to the last census. Within the public health sector, access to high-cost medication in patients with rheumatic diseases depends on the provincial government. Since 2012 it carries a registration and monitoring of patients with autoimmune diseases treated with biological drugs in this province
Objectives To determine the preference of biological agents prescribing for patients with Rheumatoid Arthritis (RA), Spondyloarthritis (SpA), Juvenile Idiopathic Arthritis (JIA), Systemic Lupus Erythematosus (SLE) and other connective tissue diseases and describe the reason for change of therapy
Methods A descriptive cross-sectional study was conducted. Registration of children and adult patients, assisted in public hospitals, with drug treatment with high-cost was done in PRIS (Integrated Health Programs) belonging to the Provincial Health System TUCUMAN, from January 2012 to June 2015. In Tucuman, biological drugs are indicated only by rheumatologists, monthly record and approval is based on local recommendations of the Argentine Society of Rheumatology. Demographics data, pathology, drug start, drug switch (2nd, 3rd or 4th choice), kind of switch, continuation or discontinuation of treatment were analyzed.
Results Of 445 registered patients with high-cost drugs, we excluded those with no rheumatic disease (example Vogt-Koyanagi-Harada), primary osteoporosis, and 1 patient with Graft vs Host Disease (sclerodermiform syndrome treated with etanercept). Treatments were then analyzed in 393 patients, 84% women, mean age 47.7 ± 13.7 years, whose diagnoses were: 321 RA (81.7%), 38 SpA (9.6%), 13 JIA (3.3%), 12 SLE (3.1%) and the rest consisting of other connective tissue diseases (vasculitis, MTDC, ITCD).
In RA the first biological drug applied was: etanercept (36%), adalimumab (25%) and tocilizumab (10%). The average treatment time with the first biological agent was 18 ± 14.6 months; 63% received treatment continuously. Required switch to another drug 68 patients (21.2%) being the most frequent cause secondary failure and the most frequently prescribed drug rituximab or tocilizumab. The same trend is maintained then the 2nd switch. Only one patient received in 3 years 5 biological agents (4 switch).
In patients with SLE, rituximab and belimumab were treatments in equal proportion (50%). In patients with SpA, etanercept was the first drug prescribed and adalimumab in 2nd place.
Conclusions In this register of patients treated with biological drugs in Tucuman, the drug of start choice was etanercept; 21.2% needed to change therapy and the most frequent cause was secondary failure.
Disclosure of Interest None declared
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