Fecha de recepción: 29/06/2017 – Fecha de aceptación: 26/09/2017
Alañón Pardo MM1, Áreas del Águila VL1, Cuadra Díaz JL2, Paulino Huertas M2, Ariza Hernández A2,
Rodríguez Martínez M1
1 Servicio de Farmacia
2 Servicio de Reumatología
Hospital General Universitario de Ciudad Real. Ciudad Real (España)
María del Mar Alañón Pardo
Calle Real, 133
13380 Aldea del Rey (Ciudad Real)
Correo electrónico: firstname.lastname@example.org
Objectives: To analyze the utilization of biological disease-modifying antirheumatic drugs (bDMARDs) prescribed in monotherapy for rheumatoid arthritis (RA) and the motive for their prescription; to evaluate their effectiveness and safety when administered alone or combined with conventional DMARDs (cDMARDs); and to determine the adherence to their subcutaneous administration and to their combined cDMARDs.
Methods: A cross-sectional study was conducted in patients with RA treated in April 2015 with bDMARDs alone (biological monotherapy [BM]) or with cDMARDs (combined therapy [CT]). Effectiveness was defined as disease activity score of 28 (DAS28) corresponding to low inflammatory activity (≤3.2) or remission (≤2.6). Safety was evaluated according to adverse effects reported by the rheumatologist. Adherence was measured by “medication possession ratio” (MPR) and self-administered questionnaire (Compliance Questionnaire Rheumatology, CQR-5). Patients were classified as “adherent” to subcutaneous FAME-b and/or FAME-c if defined as such by both measurement methods (MPR ≥80% and showing “high adherence” according to CQR-5).
Results: The study included 85 patients (28.2% BM). The main motive for BM was “intolerance/toxicity to cDMARDs” (58.3%). The percentage of patients consuming opioid analgesics was higher among patients on BM than among those on CT (45.8% vs. 16.4%, p=0.005). There were no differences (p>0.05) between BM and CT in the frequency of low inflammatory activity (16.7% vs. 20.8%), remission (45.8% vs. 39.6%), or adverse effects (12.5% vs. 32.8%). Adherence to bDMARDs was higher in patients on BM (89.5%) versus CT (77.7%) (p=0.290); 72.2% of patients were adherent to cDMARDs by both measurement methods.
Conclusions: BM is an accepted alternative to CT in patients with RA and offers similar effectiveness in terms of disease control and safety; however, at least in this study population, support with opioids is required to achieve adequate analgesic control.
Key Words: Rheumatoid arthritis, biological therapy, monotherapy, combined therapy.
Download PDF: Utilización de fármacos biológicos en artritis reumatoide: monoterapia y terapia combinada