title: Three years experience with the prescription of anti-TNF-alpha inhibitors at Dr Soliman Fakeeh Hospital in Jeddah, Saudi Arabia.
abstract: OBJECTIVE
  To document the difficulties that are associated with the prescription of anti-TNF inhibitors due to their high cost for patients with various autoimmune rheumatic diseases in the Kingdom of Saudi Arabia.
  
  
  METHODS
  Patients who had been prescribed anti-TNF inhibitors for the treatment of autoimmune rheumatic diseases at Dr. Soliman Fakeeh Hospital in the Kingdom of Saudi Arabia from 2005 to July 2008 were retrospectively included in this study. Data collected included patients' demographics, funding methods, treatment doses and assessment results.
  
  
  RESULTS
  Thirty-six patients were included in this study. Seventy percent of these were covered by various insurance packages while 30% were paying cash for their treatment. Of those 36 patients, seven dropped out within the first 2 months of treatment. Thereafter, a gradually increasing number of patients either discontinued treatment or were no longer compliant with their scheduled injection dates. There was a statistically highly significant correlation between financial difficulties and discontinuing treatment and/or spacing-out the administration of anti-TNF agents (P < 0.001). On the other hand, neither safety nor efficacy profiles were shown to significantly impact drug discontinuation. The impact of financial difficulties tended to be more prominent during the first 6 months of treatment.
  
  
  CONCLUSIONS
  Financial issues appear to be the major factor that is interfering with the compliance with treatment with anti-TNF agents in the Kingdom of Saudi Arabia. The anti-TNF agents studied were generally well tolerated and were effective.
authors.affiliation: Dr Soliman Fakeeh Hospital, PO BOX 2537, Jeddah 21461, Saudi Arabia. hatem@hatemeleishi.com
authors.forename: Hatem Hamdi
authors.initials: HH
authors.lastname: Eleishi
authors.forename: Nader Farid
authors.initials: NF
authors.lastname: Toma
authors.forename: Moustapha Cherif
authors.initials: MC
authors.lastname: Chaki
authors.forename: Hanan Rabee
authors.initials: HR
authors.lastname: Nada
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007342:Insurance Benefits; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000191:economics; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000191:economics; D012529:Saudi Arabia; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha