(P-394) Clinical Effectiveness of Anti-tnf, Non-anti-tnf and Tofacitinib in the Treatment of Rheumatoid Arthritis

Background: Rheumatoid Arthritis (RA) is a systemic, chronic and inflammatory disease, which leads to deformity and destructions of joints.

Objectives: To evaluate the effectiveness of the biological disease-modifying antirheumatic drugs (bDMARDs) and target-specific synthetic disease-modifying antirheumatic drugs (tsDMARD) in the treatment of RA patients attended by a pharmacy at the Public Health System (PHS), in Belo Horizonte city, Minas Gerais State, Brazil.

Methods: A prospective cohort was performed in patients adults with RA, and who received some bDMARDs or tsDMARD in the PHS from March/2011 to December/2020. Three groups were evaluated: anti-TNF (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), non-anti-TNF (abatacept, tocilizumab) and tofacitinib. Information about sociodemographic and clinical characteristics was collected. The patients were interviewed at the beginning and six months of follow-up. Effectiveness was assessed by the Clinical Disease Activity Index (CDAI), functionality by the Health Assessment Questionnaire (HAQ) and quality of life by the European Quality of Life 5 dimensions (EQ-5D). The drugs were considered effective when the patient achieved remission or low-disease activity by CDAI. Tables of frequency, mean, Pearson's Chi-square and ANOVA were used.

Results: A total of 836 patients were included in the study. Of these, 78.5% started the treatment with anti-TNF, 15.1% with non-anti-TNF and 6.5% with tofacitinib. Most were women (87,7%), white (40,6%) and married (56,7%). Also, the mean age and the diagnosis time were 53.4 (SD 13,39) and 10.62 (SD 9,36) years, respectively. There were differences among groups at baseline for age; diagnosis time; ethnicity; concomitant use of nonsteroidal anti-inflammatory drugs, corticosteroids and conventional synthetic disease-modifying antirheumatic drugs; previous use of bDMARDs, mean of HAQ and CDAI (p < 0.05). The study showed a statistically significant improvement in patients with the use of anti-TNF, non-anti TNF and tofacitinib, with a reduction in the mean CDAI and HAQ and an increase in EQ-5D, except for HAQ for tofacitinib group. Anti-TNF, non-anti-TNF and tofacitinib were effective in 42,2%, 25,0% and 27,3% of patients at six months, respectively.

Conclusions: The RA patients showed improvement with the use of bDMARDs and tsDMARD. However, about 60% of patients did not reach the expected treatment response by CDAI at six months of treatment.