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

Ronaldo José Faria; Francisca Janiclecia Rezende Cordeiro; Jéssica Barreto Ribeiro Dos Santos; Juliana Alvares-Teodoro; Augusto Afonso Guerra Júnior; Francisco de Assis Acurcio; Michael Ruberson Ribeiro da Silva

doi:10.3389/fphar.2022.878972

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

Front Pharmacol. 2022 Apr 26:13:878972. doi: 10.3389/fphar.2022.878972. eCollection 2022.

Authors

Ronaldo José Faria^{1

2}, Francisca Janiclecia Rezende Cordeiro², Jéssica Barreto Ribeiro Dos Santos^{1

2}, Juliana Alvares-Teodoro³, Augusto Afonso Guerra Júnior³, Francisco de Assis Acurcio³, Michael Ruberson Ribeiro da Silva^{1

2}

Affiliations

¹ Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil.
² Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil.
³ Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Abstract

Background: Conventional synthetic disease-modifying antirheumatic drugs are the first-line treatment to inhibit the progression of psoriatic arthritis. Despite their widespread clinical use, few studies have been conducted to compare these drugs for psoriatic arthritis. Methods: a longitudinal study was carried out based on a centered patient national database in Brazil. Market share of drugs, medication persistence, drug costs, and cost per response were evaluated. Results: a total of 1,999 individuals with psoriatic arthritis were included. Methotrexate was the most used drug (44.4%), followed by leflunomide (40.6%), ciclosporin (8.2%), and sulfasalazine (6.8%). Methotrexate and leflunomide had a greater market share than ciclosporin and sulfasalazine over years. Medication persistence was higher for leflunomide (58.9 and 28.2%), followed by methotrexate (51.6 and 25.4%) at six and 12 months, respectively. Leflunomide was deemed the most expensive drug, with an average annual cost of $317.25, followed by sulfasalazine ($106.47), ciclosporin ($97.64), and methotrexate ($40.23). Methotrexate was the drug being the lowest cost per response. Conclusion: Methotrexate had the best cost per response ratio, owing to its lower cost and a slightly lower proportion of persistent patients when compared to leflunomide. Leflunomide had a slightly higher medication persistence than methotrexate, but it was the most expensive drug.

Keywords: antirheumatic agents; drug costs; medication adherence; pharmacoepidemiology; psoriatic arthritis.