title: Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is an autoimmune disease cause of disability and high costs. To determine the effectiveness of therapy with biologic- and disease-modifying antirheumatic drugs (DMARDs) in patients with RA and factors associated with the control of the disease.
  
  
  METHODS
  Retrospective cohort study of RA patients receiving treatment with DMARDs in a rheumatologic healthcare institution in five Colombian cities from December 2009 to August 2013. The effectiveness was assessed by Disease Activity Score-28 (DAS-28) and a lower value of 2.6 was considered remission.
  
  
  RESULTS
  A total of 827 patients were studied for an average observation period of 17.3 ± 11.0 months, with mean age 54.3 ± 13.1 years. The most frequently used DMARDs were methotrexate, leflunomide and chloroquine. The most frequently used biological DMARDs were etanercept and abatacept. Initially, 17.8% of the patients received some biological DMARDs in comparison with 28.7% at the end of the observation period. A median DAS28 of 3.5 was found, which was reduced by the end of the observation period to 2.8 (p < 0.001), and cases of patients who were in remission increased from 30.1% to 42.9%. Treatment with leflunomide (OR: 0.47; CI 95%: 0.35-0.64, p < 0.001) or rituximab (OR: 0.37; CI 95%: 0.17-0.83, p = 0.016) was associated with a lesser probability of reaching remission. To be treated in the city of Manizales (OR: 2.56; CI 95%: 1.36-4.82, p = 0.004) was associated with a high probability of remission.
  
  
  CONCLUSIONS
  Biological and DMARDs therapy for RA was effective in a relevant proportion of Colombian patients as a consequence of management with strategies set on remission aims quantified using DAS28. Cost-effectiveness of the therapy must be evaluated.
authors.affiliation: Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Pereira, Colombia.
authors.forename: J E
authors.identifier: http://orcid.org/0000-0002-8455-0936
authors.initials: JE
authors.lastname: Machado-Alba
authors.affiliation: Farmacoeconomía-Audifarma S.A. Bogotá, Pereira, Colombia.
authors.forename: A F
authors.initials: AF
authors.lastname: Ruiz
authors.affiliation: Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia.
authors.forename: M E
authors.initials: ME
authors.lastname: Machado-Duque
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D001688:Biological Products / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products; D007555:Isoxazoles; D000069594:Abatacept; D002738:Chloroquine; D000077339:Leflunomide; D000068800:Etanercept; D008727:Methotrexate