title: Adherence to guidelines in the use of biological agents to treat psoriasis in Brazil.
abstract: OBJECTIVE
  In São Paolo, Brazil, patients can appeal to the courts, registering law suits against the government claiming the need for biological agents for treatment of psoriasis. If the lawsuits are successful, which is usually the case, the government then pays for the biologic agent. The extent to which the management of such patients, after gaining access to government payment for their biologic agents, adheres to authoritative guidelines, is uncertain.
  
  
  METHODS
  We identified patients through records of the State Health Secretariat of São Paulo from 2004 to 2011. We consulted guidelines from five countries and chose as standards only those recommendations that the guidelines uniformly endorsed. Pharmacy records provided data regarding biological use. Guidelines not only recommended biological agents only in patients with severe psoriasis who had failed to respond to topical and systemic therapies (eg, ciclosporin and methotrexate) but also yearly monitoring of blood counts and liver function.
  
  
  RESULTS
  Of 218 patients identified in the database, 3 did not meet eligibility criteria and 12 declined participation. Of the 203 patients interviewed, 91 were still using biological medicine; we established adherence to laboratory monitoring in these patients. In the total sample, management failed to meet standards of prior use of topical and systemic medication in 169 (83.2%) patients. Of the 91 patients using biological medicine at the time of the survey, 23 (25.2%) did not undergo appropriate laboratory tests.
  
  
  CONCLUSIONS
  Important discrepancies exist between clinical practice and the recommendations of guidelines in the management of plaintiffs using biological drugs to treat psoriasis.
authors.affiliation: Programa de Pós-Graduação em Ciências Farmacêuticas da Universidade de Sorocaba, Sorocaba, Sao Paulo, Brazil.
authors.forename: Miriam Sanches do Nascimento
authors.initials: MS
authors.lastname: Silveira
authors.forename: Iara Alves
authors.initials: IA
authors.lastname: de Camargo
authors.forename: Claudia Garcia Serpa
authors.initials: CG
authors.lastname: Osorio-de-Castro
authors.forename: Silvio
authors.initials: S
authors.lastname: Barberato-Filho
authors.forename: Fernando de Sá
authors.initials: Fde S
authors.lastname: Del Fiol
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: Mayara Costa
authors.initials: MC
authors.lastname: de Camargo
authors.forename: Luciane Cruz
authors.initials: LC
authors.lastname: Lopes
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001685:Biological Factors / Q000009:adverse effects / Q000627:therapeutic use*; D001772:Blood Cell Count; D001938:Brazil; D005260:Female; D019983:Guideline Adherence / Q000331:legislation & jurisprudence; D006801:Humans; D007880:Legislation, Drug; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence / Q000592:standards*; D011565:Psoriasis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D001685:Biological Factors
keywords: Clinical Pharmacology