Infliximab is a chimeric monoclonal antibody. Published studies indicate that its use in patients with rheumatoid arthritis can be efficient in providing long-term benefits. The aim of this study is to evaluate the efficacy and safety of using infliximab for the treatment of rheumatoid arthritis. A systematic review was performed to search for randomized clinical trials that compared intravenous administration of 3 mg/kg body weight infliximab or placebo in patients concomitantly using methotrexate. Only studies of moderate or high quality were included. A meta-analysis was conducted to assess the efficacy (based on changes of American College of Rheumatology (ACR) criteria) and the safety (based on serious adverse events, serious infections, malignancy, and deaths) of infliximab use. Withdrawals due to adverse events or lack of efficacy were also evaluated in both infliximab-treated and control groups. Seven trials met the inclusion criteria, comprising 2,129 patients. In the efficacy meta-analysis, a greater number of infliximab-treated patients relative to those in the placebo group achieved ACR20, ACR50, and ACR70 values from 14 weeks to 2 years of treatment. For safety analysis, there were no statistically significant differences between the groups. Withdrawals due to adverse events were higher in the infliximab group relative to the placebo group, and withdrawals due to lack of efficacy were higher in the placebo group relative to the infliximab-treated group. This meta-analysis shows a higher efficacy of infliximab relative to placebo without significant safety differences between the infliximab-treated and control groups.

Introduction: The Brazilian Unifi ed Health Care System (SUS) offers treatment for patients with RA through federal funding (Ministry of Health) and state co-fi nancing. The Clinical Protocol and Therapeutic Guidelines for the treatment of rheumatoid arthritis describe the therapeutic regimen for the disease, including the anticytokines adalimumab, etanercept or infl iximab. Objectives: The aim of this study was to evaluate the profi le of registered users of those anticytokines, biologics registered in the Information System of the Pharmaceutical Assistance Specialized Division, managed by the Paraná State Drug Center. Methods: A cross-sectional study regarding data from March 2010 was conducted. Based on dispensation data, information regarding the following variables were collected: age; gender; regional health care centers; International Classifi cation of Diseases (ICD); and drug dispensed. In addition, the monthly cost with anticytokines for the SUS was calculated. Results: In the state of Paraná, 923 patients on anticytokines were identifi ed, 40%, 44% and 16% of whom receiving adalimumab, etanercept and infl iximab, respectively. This generated a monthly cost of R$3,403,195.59. Regarding the ICD, the distribution of patients was as follows: 55% had ICD M05.8; 27%, ICD M06.0; 9%, ICD M6.8; 8%, ICD M5.0; and 1% had other ICDs related to the disease. The regional health care centers of the state of Paraná with the largest number of patients on anticytokines were in the following municipalities: Ponta Grossa; Cornélio Procópio; Londrina; Cianorte; Maringá; Irati; and Campo Mourão. Conclusion: This study assessed the distribution and profi le of users of anticytokines for the rheumatoid arthritis treatment covered by the SUS in the state of Paraná, in March 2010.

Resumo: este estudo objetivou realizar uma avaliação econômica das anticitocinas adalimumabe (ada), etanercepte (eta) e infliximabe (IFX) para o tratamento da artrite reumatoide no estado do Paraná, sob a perspectiva do sus. os dados de eficácia e segurança dos tratamentos foram buscados na literatura, e os custos foram calculados com valores gastos pelo sus para cada um dos tratamentos. Foi elaborado o modelo de Markov para obter a relação custo-efetividade de cada tratamento. a relação custo-efetividade incremental (ICeR) comparado ao tratamento padrão também foi calculada para cada anticitocina. análises de sensibilidade e taxas de desconto foram aplicadas. na avaliação custoefetividade, encontraram-se custos por QalY de R$ 511.633,00, R$ 437.486,00 e R$ 657.593,00 para ada, eta e IFX, respectivamente. o ICeR por QalY foi R$ 628.124,00, R$ 509.974,00 e R$ 965.927,00 para ada, eta e IFX, respectivamente. nas análises de sensibilidade, o eta e o ada apresentaram valores próximos. Cabe aos gestores públicos e aos médicos prescritores a escolha adequada para cada paciente, entre os tratamentos disponibilizados. Palavras-chave: artrite reumatoide; custo-efetividade; QALY.

Treatment for chronic hepatitis B in Brazil are funded by the Ministry of Health and by the state Departments of Health. Clinical protocol and therapeutic guidelines approve the use of adefovir, entecavir, interferon-α, lamivudine, and tenofovir for the treatment of chronic hepatitis B. The aim of this study was to establish the profile of users of these drugs in the state of Paraná. A cross-sectional study was conducted with patients under treatment in Paraná in August 2011. The following data were obtained: gender, hepatitis B used drug, International Classification of Diseases, and regional health unit. The monthly cost of these drugs for the public health system was also calculated. 1,093 patients registered were found, 70% male, and 2.6% co-infected with the delta agent. Tenofovir was the drug most commonly used (355 users). The highest prevalence was found in the regional health units of Pato Branco, Cascavel, Foz do Iguaçú, Francisco Beltrão, Toledo, Londrina, and Maringá. The annual cost for the public health system in Paraná was U$1,066,867. Through this study it was possible to investigate the distribution and profile of users of drugs for the treatment of chronic hepatitis B in Paraná in August 2011.

Objective: Diabetes mellitus (DM) is a serious public health problem in Brazil. The goal of this study was to evaluate the effectiveness of long-acting insulin analogues in controlling glycemia in type 1 DM patients and to analyze the direct costs of the treatment. Methods: A retrospective cohort study was undertaken with data collected from the State Health Secretary's 2 nd Regional Health Center from the State of Paraná. After randomization, socio-demographic data, the source of their drug prescriptions, and the pharmacotherapeutic profiles of the drugs were collected, along with clinical outcome information, such as glycated hemoglobin (HbA 1c ) and fasting plasma glucose levels. The direct costs of treatment with analogue insulin were evaluated based on the drugs and supplies acquisition data from the Center for Drugs, Paraná Cemepar. Results: One hundred and forty-eight type 1 diabetes mellitus patients, older than 18 years of age, were included in the cohort study. The HbA 1c reduction after the insulin treatment was 0.36 ± 2.75, and the direct costs to reduce this parameter by 1% over a period of 24 months were U$ 1,806. The estimated costs to reduce HbA 1c by 1% are U$ 5,016. Conclusions: In this study, we were able to estimate the public health system costs of using insulin analogues to reduce HbA 1c by 1% in patients with type 1 DM. This information will assist clinicians in decision-making regarding insulin treatment. RESUMOObjetivo: Diabetes mellitus (DM) é um grave problema de saúde pública no Brasil. O objetivo deste estudo foi avaliar a redução da HbA 1c em pacientes usuários de insulinas análogas de longa duração no controle glicêmico de pacientes com DM tipo 1 e avaliar custos diretos do tratamento com insulinas análogas. Métodos: O estudo é uma coorte retrospectiva e análise de custos para o tratamento de DM tipo 1, com pacientes pertencentes a 2 a Regional de Saúde do estado do Paraná. Após