OBJECTIVES : To report treatment patterns of biological drugs and tofacitinib for rheumatoid arthritis (RA) in the Brazilian Public Health System (SUS).

METHODS : Retrospective analysis of treatment profile and sequence was developed according to Ambulatory Information System (SIA/SUS) database, from January/2013 to July/2019. The analysis considered biological drugs available in the SUS and tofacitinib. A drug survival analysis was performed to compare the time of first biological treatment using Cox proportional-hazards model.

RESULTS : The number of RA patients on treatment increased from 7,388 in 2013, 15,613 in 2014, 22,816 in 2015, 29,306 in 2016, 35,486 in 2017, 39,792 in 2018 to 34,769 in 2019 (in 7 months). In total, 55,074 patients were treated with biologics drugs or tofacitinib at some point, being 40% with adalimumab, 30% with etanercept, 13% with golimumab, 9% with tocilizumab, infliximab and abatacept each, 8% with certolizumab, 5% with rituximab and 1% with tofacitinib.

Adalimumab was the first biological treatment for 36%, followed by etanercept (27%), golimumab (11%), infliximab (8%), certolizumab (6%), tocilizumab and abatacept (4% each) and rituximab (3%). One treatment (patients without switch) was registered for 79%, while 16% registered two, 3% three and 1% four or more. Of the 21% who switch between treatments, the most frequent were from adalimumab to etanercept (2%) and from etanercept to adalimumab (2%). The switch from adalimumab to tocilizumab or abatacept was observed for 1%, each. The switch from anti-TNF to rituximab was observed in 1% of cases, being 0.4% from adalimumab, 0.3% from etanercept, 0.1% from golimumab and 0.1% from infliximab.

Cox regression showed that among biological drugs etanercept had the longest treatment time.

CONCLUSIONS : Data from SUS showed the RA treatment pattern considering the use of biological drugs and tofacitinib. In general, the observed data are consistent with the Brazilian recommendations for RA treatment in the SUS.