(057) Spatial-Temporal Patterns In Biologic Prescriptions For Inflammatory Bowel Diseases In The Public Healthcare System In Brazil

Background: Limited research exists on the prescription patterns of biologics for inflammatory bowel diseases (IBD) in Latin America. Exploring this topic can help address knowledge gaps, improve disease management, and reduce disease burden.

Objectives: To examine the spatial and temporal biologic prescription patterns for IBD in Brazil's public health system (SUS).

Methods: This ecological study analyzed data from individuals with Inflammatory Bowel Disease (IBD) in the SUS Outpatient Information System from 2008 to 2022. Prais-Winsten regression was applied to examine the trends in the prescription rates of four biologic drugs: infliximab, adalimumab, certolizumab pegol, and vedolizumab. Moran's global index (GMI) and the local spatial autocorrelation index (LISA) were used to evaluate spatial autocorrelation and identify spatial clusters of biologic prescriptions, respectively, for each municipality during three periods: 2008-2012, 2013-2017, and 2018-2022.

Results: Biological prescription rate has increased from 3.0% to 16.7% between 2008 and 2022. Infliximab was the most frequently prescribed medication from 2008 to 2012 (3.0%–4.2%), while adalimumab held that distinction from 2013 to 2022 (4.3%–9.1%). A higher rate of biological prescriptions was observed in patients with Crohn's disease than in those with ulcerative colitis (40.5% vs. 3.2%, respectively). From 2008-2012, the average biologic prescription rate was 5.7%, with a higher rate of 9.3% in the central-western region. Two percent of the municipalities were high-prescription spatial clusters, with 52.9% in the southeastern region. Between 2013-2017, the average prescription rate increased to 12.2%, with a higher rate of 17.9% in the central-western region. About 3.4% of the municipalities were in high clusters, of which 39.0% were in the northeast region. Between 2018-2022, the average biologic prescription rate was 17.0%, with the highest rate of 23.5% in the northern region. Nearly 5.0% of the municipalities were in high clusters, with 31.7% in the northeastern region.

Conclusions: The growing effectiveness of biologics in achieving and sustaining remission for IBD may lead to an increase in their usage. Additionally, the ease of administering adalimumab through subcutaneous injection may have contributed to its increased usage compared with infliximab.