(023) Medication persistence in the treatment of rheumatoid arthritis in the Brazilian Public Health System

Background: Rheumatoid Arthritis (RA) is one of the most prevalent chronic inflammatory diseases in the world and can lead to the destruction of cartilage and joints through bone erosion. The objective of treatment is to improve functional capacity and quality of life and failure to achieve therapeutic goals may lead to changes in the therapeutic regimen.

Objective: To determine the persistence of medications in the treatment of Rheumatoid Arthritis (RA) in the Unified Health System (SUS) from 2017 to 2021.

Objectives: To determine the persistence of medications in the treatment of Rheumatoid Arthritis (RA) in the Unified Health System (SUS) from 2017 to 2021.

Methods: Retrospective cohort, from January 2017 to December 2021, with data from users who received at least one biological disease-modifying drug (MMCDbio) or specific synthetic target (MMCD-S-JAK), registered in the Open Health Intelligence Room – Sabeis/Datasus, with at least one year of follow-up in the cohort. The overall persistence was evaluated, from time zero until interruption or change of medication, using the Kaplan-Meier method and the differences in the curves using the log-rank; persistence was stratified by sex, age group, region of residence, BMI, ICD-10, therapeutic class and therapeutic regimen. Cox multivariate logistic regression verified the correlation between sociodemographic variables and treatment discontinuation, at 12 and 24 months of follow-up

Results: 33,270 patients were evaluated. In the univariate analysis, age, region of residence, class and therapeutic regimen were statistically significant. Considering the discontinuation rate and the median discontinuation time, the best performance was seen in individuals over 65 years of age (78.8%; 11 months – CI 11.6 – 12.4), residing in the South region (74.4 %; 14 months - 95% CI 13.3 – 14.7), using MMCD-S-JAK (63.0% and 14 months - 95% CI 13.0 – 14.9) and medication modifying the course of the disease interleukin inhibitor (DMCD-B-IL) (73.6% and 12 months - 95% CI 11.2 – 12.8), using a single-drug therapeutic regimen (77.6%; 14 months - 95% CI 13.3 – 14.7). Multivariate analysis confirmed a lower risk of discontinuation among patients over 65 years of age, living in the southern region of the country, using DMARD-JAK and using a single-drug therapeutic regimen, both with 12 and 24 months of follow-up in the cohort.

Conclusions: The MMCD-S-JAK class showed greater persistence compared to other therapeutic options. It is worth noting that it is a class of medications used orally, which increases the convenience of administration.