Exchange of biological medicines in rheumatoid arthritis: courts of users of the single health system



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TROCA DE MEDICAMENTOS BIOLÓGICOS NA ARTRITE REUMATOIDE: COORTE DE USUÁRIOS DO SISTEMA ÚNICO DE SAÚDE

SWITCHING OF BIOLOGICAL DRUGS IN RHEUMATOID ARTHRITIS (RA): COHORT OF USERS OF THE HEALTH CARE SYSTEM

EXCHANGE OF BIOLOGICAL MEDICINES IN RHEUMATOID ARTHRITIS: COURTS OF USERS OF THE SINGLE HEALTH SYSTEM

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OBJETIVOS: Estimar a incidência e identificar os fatores associados à troca de medicamentos biológicos na artrite reumatoide (AR).

Objectives: Estimate the incidence and identify the factors associated with the switch of biologic drugs in rheumatoid arthritis (RA).

To estimate the incidence and identify factors associated with the exchange of biological drugs in rheumatoid arthritis (RA)

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MÉTODOS: Estudo de coorte.

Methods: cohort study.

METHODS: A cohort study

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Definiu-se como desfecho primário a troca de medicamentos biológicos.

The primary endpoint was the switch of biologic drugs .

The primary outcome was the exchange of biological drugs

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Partiu-se dos registros administrativos nacionais da APAC-SIA-SUS entre 2008 e 2014.

It was based on the national administrative records of APAC-SIA-SUS between 2008 and 2014.

The APAC-SIA-SUS national administrative records were drawn up between 2008 and 2014

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Incluíram-se os códigos M050, M051, M052, M053, M058, M060, M068 e M080 da CID-10 e que continham os medicamentos abatacepte, adalimumabe, certolizumabe, etanercepte, golimumabe, infliximabe, rituximabe e tocilizumabe.

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The ICD-10 codes M050, M051, M052, M053, M058, M060, M068, M068 and M080 which contained abatacepte, adalimumab, etanercept, certolizumabe, golimumabe, infliximabe, rituximab and tocilizumab were considered.



The ICD-10 codes M050, M051, M052, M053, M058, M060, M068, M068 and M080 included abatacept, adalimumab , Certolizumab, etanercept, golimumab, in fl uxime, rituximab and tocilizumab

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Aninharam-se os registros pelo número do Cartão Nacional de Saúde, para acompanhamento trimestral.

The records were gathered according to the National Health Card number for a quarterly monitoring.

The records were nested by the National Health Card number, for quarterly follow-up

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Os fatores associados à troca de biológicos foram avaliados por regressão de Cox, que permitiu o cálculo do hazard ratio (HR) ajustado por sexo e idade.

The factors associated with the switch of the biologic drugs were evaluated using Cox regression, which enabled the measure of the hazard ratio (HR), adjusted for gender and age.

Factors associated with the exchange of biological were evaluated by Cox regression, which allowed the calculation of the hazard ratio (HR) adjusted for sex and age

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Procederam-se a todos os cálculos no STATA (v. 14.1) e definiu-se o intervalo de confiança a 95% (IC 95%).

All calculations were performed in STATA (see 14.1) with a confidence interval of 95% (CI 95%).

All STATA calculations were performed (see 14.1) and the 95% confidence interval (95% CI) was defined

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RESULTADOS: Foram identificados 65.617 pacientes (159.907 pacientes-ano), 76% mulheres, idade média 48 ± 15 anos.

RESULTS: We identified 65,617 patients (out of 159,907 patients-a-year), 76% women, mean age of 48 ± 15 years.

RESULTS: We identified 65 617 patients (159 907 patient-years), 76% women, mean age 48 ± 15 years

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Referente ao diagnóstico, 39% foram codificados como outras AR soropositivas, 23% como AR soronegativa e 20% como síndrome de Felty.

Regarding diagnosis, 39% of the patients were coded as other seropositive RAs , 23% as seronegative RAs and 20% as Felty's syndrome.

Regarding the diagnosis, 39% were coded Like other seropositive RAs, 23% as seronegative AR and 20% as Felty's syndrome

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Em todo o período, a primeira escolha para o tratamento foi adalimumabe (45%), etanercepte (32%) e infliximabe (18%).

Throughout the period, the first choice for the treatment was adalimumab (45%), etanercept (32%) and infliximabe (18%).

Throughout the period, the first choice for treatment was adalimumab (45%), etanercept (32%) and in fl uxime (18%)

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Em cinco anos, 17% trocaram de biológico.

In five years, 17% of the patients switched their biologic drugs.

In five years, 17% changed biological

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A maior frequência de troca substituiu infliximabe pelo adalimumabe.

The highest frequency of switch occurred in adalimumab over infliximabe.

The higher frequency of exchange replaced in fl iximab with adalimumab

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A troca associou-se às seguintes características: mulheres (HR: 1,4; IC95% 1,3-1,5), idade até 60 anos (HR: 1,6; IC95% 1,5-1,8), doença reumatoide no pulmão (HR: 1,4; IC95% 1,1-1,9) e tratamento em 2008 (HR: 2,1; IC95% 1,9-2,2).

The switch was associated with the following features: women (HR: 1.4; 95% CI 1.3 -1.5), age up to 60 years (HR: 1.6; 95% CI 1.5 -1.8) pulmonary manifestations of rheumatoid arthritis (HR: 1.4; 95% -1.9 1.1) and treatment in 2008 (HR: 2.1; 95% CI 1.9 -2.2).

The exchange was associated with the following characteristics: women (HR: 1.4; 95% CI 1.3-1.5), age up to 60 years (HR: 1.6; 95% CI 1.5-1.8), Rheumatoid arthritis in the lung (HR: 1.4; 95% CI 1.1-1.9) and treatment in 2008 (HR: 2.1; 95% CI 1.9-2.2)

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O infliximabe teve a maior frequência de troca (7/100 pacientes-ano), e o golimumabe a menor (4/10.000 pacientes-ano).

Infliximabe had the highest switching frequency (7/100 patients-a-year), and golimumabe had the lowest r (4/10,000 patients-a-year).

In fl iximab had the highest switching frequency (7/100 patient-years), and golimumab the lowest (4 / 10,000 patient-years).

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CONCLUSÃO: Aproximadamente um a cada cinco pacientes com AR troca de biológicos.

CONCLUSION: Approximately one in five patients with RA switches biologic drugs. .

CONCLUSION: Approximately one in five patients with RA exchange of biological

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Essa troca é mais observada em mulheres, pessoas jovens e nas que apresentam a doença no pulmão.

This switch is most seen among women, young people and among those who have RA in the lungs.

This change is most seen in women, young people, and those with lung disease.


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