Francisco de Assis Acurcio1,2,3, Augusto Afonso Guerra Junior1,2, Michael Ruberson Ribeiro da Silva1,2, Ramon Gonçalves Pereira1,2, Brian Godman4,5,6, Marion Bennie4, Hacene Nedjar7, Elham Rahme7,8. 1. Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil. 2. SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil. 3. Department of Social and Preventive Medicine, Post-graduated Program of Public Health, School of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil. 4. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom. 5. Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden. 6. Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom. 7. Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada. 8. Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada.
Abstract
Objective: To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis (AS) living in Brazil and Quebec, Canada. Methods: We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. Results: One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1 and 30.7%, Quebec: 66.9 and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9 and 18.1%, Quebec: 51.5 and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.Conclusions: Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.
Objective: To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis (AS) living in Brazil and Quebec, Canada. Methods: We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. Results: One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1 and 30.7%, Quebec: 66.9 and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9 and 18.1%, Quebec: 51.5 and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.Conclusions: Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.
Authors: Ludmila Peres Gargano; Isabella de Figueiredo Zuppo; Mariana Martins Gonzaga do Nascimento; Valéria Maria Augusto; Brian Godman; Juliana de Oliveira Costa; Francisco Assis Acúrcio; Juliana Álvares-Teodoro; Augusto Afonso Guerra Journal: Front Big Data Date: 2022-02-07
Authors: Ana F Souza; Michael R Da Silva; Jéssica B Dos Santos; Alessandra M Almeida; Francisco A Acurcio; Juliana Alvares-Teodoro Journal: Pharm Pract (Granada) Date: 2021-05-28