title: Comparative effectiveness of adalimumab and etanercept for rheumatoid arthritis in the Brazilian Public Health System.
abstract: Biological disease-modifying antirheumatic drugs (bDMARDs) are used to treat rheumatoid arthritis (RA) with adalimumab and etanercept the most used bDMARDs in Brazil. This open prospective cohort study evaluated their effectiveness and safety among RA patients in the Brazilian Public Health System given their costs.
  
  
  
  The Clinical Disease Activity Index was primarily used to assess their effectiveness after 6 and 12 months of follow-up. The Health Assessment Questionnaire and EuroQol-5D were also used.
  
  
  
  A total of 266 RA patients started treatment with adalimumab or etanercept. Adalimumab was the most widely used bDMARD (70%). In total, 46% achieved remission or low-disease activity at 12 months with no difference in effectiveness between them (p = 0.306). bDMARDs were more effective in patients who had better functionality at treatment onset and had spent longer in education.
  
  
  
  This real-world study demonstrated that adalimumab and etanercept are equal alternatives for RA treatment and both were well tolerated.
authors.affiliation: Postgraduate Program in Medicines & Pharmaceutical Assistance, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
authors.forename: Jéssica Barreto Ribeiro
authors.initials: JB
authors.lastname: Dos Santos
authors.affiliation: College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
authors.forename: Alessandra Maciel
authors.initials: AM
authors.lastname: Almeida
authors.affiliation: College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
authors.forename: Francisco de Assis
authors.initials: FA
authors.lastname: Acurcio
authors.affiliation: Postgraduate Program in Medicines & Pharmaceutical Assistance, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
authors.forename: Haliton Alves
authors.initials: HA
authors.lastname: de Oliveira Junior
authors.affiliation: Medicine School, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais 30130-100, Brazil.
authors.forename: Adriana Maria
authors.initials: AM
authors.lastname: Kakehasi
authors.affiliation: College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
authors.forename: Augusto Afonso
authors.initials: AA
authors.lastname: Guerra Junior
authors.affiliation: Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK.
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
authors.affiliation: Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK.|Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.affiliation: College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Alvares
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Brazil; adalimumab; cohort study; effectiveness; etanercept; rheumatoid arthritis