Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient’s pharmacological treatment was evaluated by comparing the patient’s current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.

Objective: To evaluate the association between adherence to treatment and mortality among Chronic Obstructive Pulmonary Disease (COPD) patients treated in the Brazilian public health system. Methods: This is cohort study of moderate-to-severe COPD patients monitored in a public pharmaceutical care-based Disease Management Program (DMP). All subjects who died one year after the beginning of the cohort were age-matched with those who remained alive at the end of the cohort period. Treatment adherence was measured through pharmacy records. Patients who received at least 90% of the prescribed doses were considered adherent to treatment. Results: Of the 333 patients (52.8% age = 65 years, 67.9% male), 67.3% were adherent to treatment (adherence rate, 87.2%). Mortality was associated with lack of adherence (p = 0.04), presence of symptoms (mMRC = 2) and COPD treatment use. The death was associated with non-adherence, presence of symptoms and previous hospitalization. After adjustment, non-adherent patients to treatment were almost twice times likely to die compared to those adherents (Hazard Ratio (HR) 1.86; CI 1.16-2.98, p = 0.01). Conclusion: Non-adherence to treatment was associated with higher mortality among moderate-to-severe COPD patients treated in the Brazilian public health system. Strategies to monitor and optimize adherence should be strengthened to reduce COPD-related mortality.

Conclusions: This study demonstrate that biosimilar drug market increased during the period. The "Health National Strategy » biosimilar objective for 2022: 80% of market share is achievable if the market keeps the actual trend. Patient's characteristics description could be complementary to this study, to give more information to the biosimilar landscape.

Apesar da larga disponibilidade de β 2-agonistas de longa ação e anticolinérgicos de longa ação, isolados ou em combinações em doses fixas, para tratamento de manutenção da doença pulmonar obstrutiva crônica (DPOC), dados de ensaios clínicos de comparação direta de diferentes esquemas de terapias duplas são escassos. O indacaterol é β 2-agonista de ação ultra-longa recentemente lançado no mercado brasileiro que demonstrou reduzir significativamente a hiperinsuflação pulmonar em portadores de DPOC. Objetivo: Avaliar o efeito agudo do indacaterol (150 mcg) mais tiotrópio (5 mcg) versus formoterol (12 mcg) mais tiotrópio (5 mcg) sobre a hiperinsuflação pulmonar (Estudo EFINTH) em pacientes com DPOC. Métodos: Ensaio clínico randomizado, exploratório, aberto, fase IV, cruzado, de 2 períodos. Um total de 30 portadores de DPOC moderada a grave, sintomáticos, serão recrutados em um Ambulatório de Referência, em Salvador, Bahia. A espirometria e os volumes pulmonares serão mensurados antes e após 5, 30, 60, 120 e 240 min a administração dos esquemas de terapia dupla. O desfecho primário é o pico da capacidade inspiratória (CI). A área sobre a curva em 4 h para CI, volume expiratório forçado no primeiro segundo (VEF 1) e capacidade vital forçada (CVF) serão os desfechos secundários. Conclusões: Este estudo pretende explorar o efeito de dois esquemas de terapia dupla sobre a redução da CI em pacientes com DPOC e, dessa forma, fornecer dados para a concepção e implementação de estudos de eficácia em larga escala e em longo prazo.

The self-medication, when it occurs in an inadequate manner, may lead to a adverse reaction, interactions with prescribed medications, bacterial resistance and waste of health resources. This study seeks to identify the prevalence and the factors associated with self-medication in patients with COPD treated in the Brazilian public health care network. To answer this question, we prospectively made detailed questionnaires about drugs consumption with 383 patients whom came from the Health Care Networks and admitted into a Pharmaceutical Care Service of a Public Program Management COPD, in Salvador, Brazil. The prevalence of self-medication was 26.9%. The self-medication practice were associated with women with low education and a high number of comorbidities. This finding raises the discussion on the importance of a thorough evaluation of the usage pattern of drugs consumed by way of self-medication in patients with COPD, as a strategy to promote the rational use of medicines in the clinical practice.Resumo: A automedicação pode resultar em reações adversas, interações com medicamentos prescritos, resistência bacteriana e desperdício de recursos. Procurou-se identificar a prevalência e os fatores associados à automedicação em pacientes com DPOC, tratados na rede de serviços do sistema público de saúde brasileiro. Para responder a essa pergunta, foram feitas, de forma prospectiva, entrevistas (questionários) sob consumo de medicamentos com 383 pacientes oriundos daquela rede de serviços e admitidos em um programa de atenção farmacêutica de um programa público de assistência à DPOC, em Salvador, Brasil. A prevalência de automedicação encontrada foi 26,9%. A prática da automedicação estava associada com mulheres com baixo nível educacional e elevado número de comorbidades. Esse achado suscita a discussão sobre a importância de uma avaliação criteriosa sobre padrões de uso de medicamentos sob a forma de automedicação em pacientes com DPOC, como estratégia para promover o uso racional de medicamentos na prática clínica.Palavras-chave: DPOC; automedicação; atenção farmacêutica; uso racional de medicamentos.

Introduction: Despite important advances in public medicines policies in Brazil, the availability of medicines in a continuous and adequate quantity to the needs of the population is still a challenge, especially for high added value medicines. There are few studies that evaluate the Specialized Component of Pharmaceutical Services (CEAF) from the perspective of professionals involved in its governance. Objective: To describe the results of three workshops on the governance of the CEAF. Methods: Descriptive, qualitative study with discussion in groups involving key informants of the governance of Pharmaceutical Services of the State Health Secretariats (SES's). Results: Several barriers to better governance of CEAF have been identified, including issues related to financing, human resources, health unit infrastructure, medication logistics management, and information systems for managing activities. Conclusion: The implementation of new guidelines for the financing of Pharmaceutical Services, which guarantee better financial balance between the federated entities, and the better articulation between Ministry of Health and SES's were pointed out as alternatives for better governance of Pharmaceutical Services.

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Objetivos: Identificar os principais motivos e estratégias de substituição de biológicos no tratamento de pacientes com diagnóstico de espondilite anquilosante (EA), cadastrados no Componente Especializado e assistidos em um centro de infusão de um hospital universitário de Salvador, BA. Métodos: Estudo observacional transversal, com coleta de dados retrospectiva, com pacientes com diagnóstico de EA em uso de biológico e que já tenham realizado, pelo menos, uma substituição dessa classe de medicamento. Foram avaliados registros de acompanhamento farmacêutico, utilizando formulário contendo as variáveis demográficas e clínicas, histórico de tratamento com biológicos, assim como motivo de substituição. A análise estatística foi descritiva de frequência simples, com frequências absolutas e percentuais. Resultados: Dos 134 pacientes portadores de EA em uso de biológico, 22 (16,42%), já utilizaram mais de um biológico. No total, ocorreram 25 substituições, sendo que a maioria dos pacientes (86,4%) utilizou apenas dois biológicos. O tratamento de escolha foi o Infliximabe (40,9% dos casos). As substituições em todas as etapas de tratamentos ocorreram entre anti-TNFs. A falha secundária foi a principal causa de substituição em todas as etapas de tratamento, seguida por eventos adversos. Nenhum paciente apresentou falha primária ao tratamento. Conclusões: O estudo permitiu traçar o perfil de substituição de biológicos em pacientes com EA. O principal motivo de substituição foi falha secundária ao tratamento.