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Abstract
Background The Public Health System in our Autonomous Community has established a protocol for biological treatments (BTs) in rheumatoid arthritis (RA), spondyloarthropathies (SAPs) and juvenile idiopathic arthritis (JIA).
Purpose To evaluate the implementation of the BTs protocol and to analyse the use of these treatments.
Materials and Methods We analysed patients who had started treatment with BT or been switched from a previous biological treatment, since the implementation of the protocol (12/05/2011 to 29/02/2012). This document has different levels of decision based on both disease status and treatment effectiveness; RA: 1st level: infliximab or subcutaneous tumour necrosis factor inhibitor (anti-TNF) (etanercept or adalimumab); 2nd: tocilizumab or abatacept or rituximab; 3rd: golimumab or certolizumab pegol. SAPs: 1st level: infliximab or etanercept or adalimumab; 2nd: golimumab; 3rd: infliximab. JIA: 1st level: etanercept; 2nd: adalimumab or abatacept. Data collected: age, sex, diagnosis, drug used after protocol implementation, previous treatments and reasons for changing. Data Source: medical records, pharmacy database. Statistical analysis: SPSS 15.0.
Results Of 455 patients receiving BT, 73 met the inclusion criteria: 53.4% were beginning their treatment, 46.6% were treatment changes. Median age: 51.1 (±11.5) years, 76.7% were women. The percentages by pathology and gender were: RA 56.9% (women: 95.1%), SAPs 43.1% (women: 51.6%) (p < 0.05). Patients starting treatment: RA: 52.7%, SAPs 47.3%. Administration routes and drugs used: RA: subcutaneous (95.0%) and etanercept (90.0%); SAPs: subcutaneous (94.5%) and etanercept (66.7%). Changes in treatment: RA 61.8%, SAPs 38.2%, drug used after switching: RA (adalimumab 33.3%, etanercept 28.6%, tocilizumab 14.3%, rituximab 9.5%), SAPs (golimumab 61.5%, adalimumab 30.8%, etanercept 7.7%). The reasons for switching were ineffectiveness (91.2%) and intolerance (8.8%).
Conclusions The overall level of compliance with the protocol was high. The most widely prescribed drug in treatment-naive patients was etanercept. Adalimumab was the most prescribed in patients who switched treatment. Lack of effectiveness was the main reason for changing treatment.
No conflict of interest.