title: Biological drugs for the treatment of psoriasis in a public health system.
abstract: OBJECTIVE; To analyze the access and utilization profile of biological medications for psoriasis provided by the judicial system in Brazil.
  
  
  METHODS
  This is a cross-sectional study. We interviewed a total of 203 patients with psoriasis who were on biological medications obtained by the judicial system of the State of Sao Paulo, from 2004 to 2010. Sociodemographics, medical, and political-administrative characteristics were complemented with data obtained from dispensation orders that included biological medications to treat psoriasis and the legal actions involved. The data was analyzed using an electronic data base and shown as simple variable frequencies. The prescriptions contained in the lawsuits were analyzed according to legal provisions.
  
  
  RESULTS
  A total of 190 lawsuits requesting several biological drugs (adalimumab, efalizumab, etanercept, and infliximab) were analyzed. Patients obtained these medications as a result of injunctions (59.5%) or without having ever demanded biological medication from any health institution (86.2%), i.e., public or private health services. They used the prerogative of free legal aid (72.6%), even though they were represented by private lawyers (91.1%) and treated in private facilities (69.5%). Most of the patients used a biological medication for more than 13 months (66.0%), and some patients were undergoing treatment with this medication when interviewed (44.9%). Approximately one third of the patients discontinued treatment due to worsening of their illness (26.6%), adverse drug reactions (20.5%), lack of efficacy, or because the doctor discontinued this medication (13.8%). None of the analyzed medical prescriptions matched the legal prescribing requirements. Clinical monitoring results showed that 70.3% of the patients had not undergone laboratory examinations (blood work, liver and kidney function tests) for treatment control purposes.
  
  
  CONCLUSIONS
  The plaintiffs resorted to legal action to get access to biological medications because they were either unaware or had difficulty in accessing them through institutional public health system procedures. Access by means of legal action facilitated long-term use of this type of medication through irregular prescriptions and led to a high rate of adverse drug reactions as well as inappropriate clinical monitoring.
authors.affiliation: Universidade de Sorocaba, Sorocaba, SP, Brasil.
authors.forename: Luciane Cruz
authors.initials: LC
authors.lastname: Lopes
authors.affiliation: Universidade de Sorocaba, Sorocaba, SP, Brasil.
authors.forename: Miriam Sanches do Nascimento
authors.initials: MS
authors.lastname: Silveira
authors.affiliation: Universidade de Sorocaba, Sorocaba, SP, Brasil.
authors.forename: Iara Alves de
authors.initials: IA
authors.lastname: Camargo
authors.affiliation: Universidade de Sorocaba, Sorocaba, SP, Brasil.
authors.forename: Silvio
authors.initials: S
authors.lastname: Barberato-Filho
authors.affiliation: Universidade de Sorocaba, Sorocaba, SP, Brasil.
authors.forename: Fernando de Sá
authors.initials: Fde S
authors.lastname: Del Fiol
authors.affiliation: Núcleo de Assistência Farmacêutica, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
authors.forename: Claudia Garcia Serpa
authors.initials: CG
authors.lastname: Osorio-de-Castro
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D028701:Patient Rights / Q000331:legislation & jurisprudence; D011565:Psoriasis / Q000188:drug therapy*; D011634:Public Health; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal