Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study

Abstract

Background: Pharmaceutical services in Brazil provide access, supply, and rational use of drugs for all population and an effort has been made to improve the quality of these services. Biological drugs are high-cost drugs supplied in Brazil that can inhibit disease progression and improve the quality of life of psoriatic arthritis (PsA) patients. However, some patients did not achieve therapeutic goals.
 Objective: To evaluate the medication adherence and persistence of PsA patients treated with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated factors.
 Methods: A prospective observational study was performed at a single-specialty pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and clinical outcomes were evaluated at 12 months of follow-up. Medication persistence was historically compared to overall PsA patients treated in Brazil. Associated factors were identified through log-binomial regression.
 Results: One hundred ninety-seven PsA patients were included in the study, of whom 147 (74.6%) and 142 (72.1%) had medication adherence and persistence, respectively. Patients treated with infliximab presented the highest adherence (90.5%) and persistence rate (95.2%) in comparison to patients treated with other drugs, except for adalimumab versus infliximab for adherence outcome. All clinical measures significantly improved in patients with medication adherence and persistence. Medication persistence was higher for patients attended by specialty pharmacy than other PsA patients in Brazil. The associated factors to higher medication adherence were lower disease activity by BASDAI, being non-white race, and intravenous drug use. The associated factors to higher medication persistence were lower disease activity by Bath Ankylosing Spondylitis Activity Index (BASDAI), intravenous drug use, non-use of corticoids and non-steroidal anti-inflammatory drugs, and comorbidity.
 Conclusions: Patients with medication adherence and persistence had significant improvements in clinical measures, functionality, and quality of life. High medication adherence and persistence to biological therapy were observed and associated with lesser disease activity at baseline. Also, medication persistence to PsA patients attended in specialty pharmacy was higher than the overall PsA population in Brazil, which indicates the importance of pharmaceutical services to provide health care and promote the effectiveness and safety of biological therapies.

Analysis of the clinical practice of the pharmacist in a community pharmacy: A Cross-sectional Study from Brazil

“… 16 , 17 In this sense, some defense studies in Brazil have advanced in the number of studies in higher education institutions and consequently improved the population’s level of schooling in recent decades, but it still needs to overcome quality education. 5 , 9 , 12…”

“…16,17 In this sense, some defense studies in Brazil have advanced in the number of studies in higher education institutions and consequently improved the population's level of schooling in recent decades, but it still needs to overcome quality education. 5,9,12 Regarding salaries, pharmacists are concentrated in the range of R$ 1,100.00 to R$ 5,500.00. This is justified due to the current panorama of the pharmaceutical labor market in Brazil.…”

“…[6][7][8] In community pharmacies, Pharmaceutical Services (PS) contribute to the public health system in Brazil. 9 The development of these tasks, in collaboration with professionals from the multidisciplinary team, demonstrates the involvement with well-being, health and life improvement of the patient. 1 The provision of these services creates a need for skilled and qualified professionals who can perform this activity.…”

Conventional Synthetic Disease-Modifying Anti-rheumatic Drugs for Psoriatic Arthritis: Findings and Implications From a Patient Centered Longitudinal Study in Brazil

“…Medication persistence has been used as a proxy for effectiveness and safety of using antirheumatic agents ( Luttropp et al, 2019 ; Ribeiro da Silva et al, 2019 ; Souza et al, 2021 ).…”

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

“…Notably, several pharmaceutical industries have expressed interest in leveraging the expertise of pharmacists to educate patients on the proper utilization of their specialized products. 10 , 11 …”