Background In the developing world rheumatologists and their patients are struggling to implement treat to target therapy in established Rheumatoid Arthritis (RA)which means they can hardly establish remission and low disease activity which is the mainstay of the RA treatment. The main reason is the lack of conventional synthetic and biological (c and b) DMARDs in the therapeutic armamentarium as well as their high cost which increases already difficult burden of RA.
Objectives The aim of the study is to evaluate the RA treatment and treatment expenses in a group of patients with established RA in FYR of Macedonia including the availability of DMARDs.
Methods We have conducted a cross-sectional study at the University Rheumatology Clinic in Skopje, including 100 patients with established RA, who fulfilled RA classification criteria from 2010. Physical examination, laboratory analyses and DAS28 were performed and all patients filled a questionnaire with 13 questions about treatment expenses and availability.
Results There were 82 females and 18 males, with mean age of 59 and disease duration of 8.3 (SD 7,3) years and moderate disease activity DAS28 3,9+/-1,47 and 75% of seropositive RA (double positive 30%, Ant-CCP positive 30%, RF positive 15%) with mean CRP of 21,5 mg/L They spend from 10 to 100 Euros monthly (on average 27+/-17,6) for the cs DMARDs therapy. Almost 80% think that the cs DMARDs therapy is too expensive for them and 100% of them could not afford to pay or co-pay for b DMARDs. Most of the patients (49%) are using single cs DMARDs. Double and triple c DMARD therapy is used by 32% vs 17%, respectively. Even though it is highly effective, patients consider triple cs DMARD therapy expensive and with very low compliance because of the high costs and low tolerability. Only 2% of the patiens are using b DMARDS using rituximab, the only available biologic DMARD therapy in FYROM. Around 70% are taking low dose prednisolone. Almost 50% of the patients cannot take the cs DMARD therapy with a prescription and have to buy their DMARDS without any coverage from the insurance fund and the same percent have problems to find the c DMARDs with prescription because it is not available. Almost half of the patients have heard about the b DMARDs, most of them from their rheumatologist and 54% of them would like to receive it. The patient's reasons for taking b DMARDs are presented in Graph 1.
Conclusions High expenses and low availability of c DMARDs on prescription and the urgent need for b DMARDs are adding the burden of RA in developing countries including FYROM with the increased need for full coverage for conventional DMARDs and at least partial coverage of biologic DMARDs, especially anti-TNF agents by the insurance companies. The use of biosimilars might be highly appreciated in the future.
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Disclosure of Interest None declared