[Profile of spending on the treatment of rheumatoid arthritis for patients of the Unified Health System in the state of Minas Gerais - 2008-2013]. / Perfil de gastos com o tratamento da Artrite Reumatoide para pacientes do Sistema Único de Saúde em Minas Gerais, Brasil, de 2008 a 2013.

Rheumatoid arthritis (RA) is a chronic condition that affects about 1% of the adult population. In a historical cohort of Minas Gerais State, 11,573 RA patients registered in the Outpatient Information System (SIA) between 2008 and 2013 were identified. For this study we adopted the public funding body's perspective and the values were adjusted by the national inflation index (IPCA) of December 2015. Etanercept was the most expensive treatment. The mean cohort age was 52 years old and most of the patients were women. Multiple regression analysis indicated a negative association between higher expenditure and age, female sex, and diagnosis at entry in the cohort and positive association between high expenditure and the Human Development Index (HDI) of the municipality and use of tumor necrosis factor agents. This study identified the factors that have an impact on RA drug treatment expenditure. Also, we showed that methods that enable extracting demographic and expenditure data of administrative information systems may represent important tools in the construction of economic studies to subsidize economic health evaluations, especially from the standpoint of the managers.

Perfil de gastos com o tratamento da Artrite Reumatoide para pacientes do Sistema Único de Saúde em Minas Gerais, Brasil, de 2008 a 2013 / Profile of spending on the treatment of rheumatoid arthritis for patients of the Unified Health System in the state of Minas Gerais - 2008-2013

Resumo A artrite reumatoide (AR) é uma doença crônica que afeta cerca de 1% da população adulta. No estudo de coorte histórica de pacientes de Minas Gerais, registrados no Sistema de Informações Ambulatoriais (SIA), em 2008-2013, foram identificados 11.573 indivíduos. A perspectiva foi a do financiador público e os valores observados como gastos do Sistema Único de Saúde (SUS) foram ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA), de dezembro de 2015. O Etanercept foi o tratamento mais caro. A análise múltipla mostrou uma relação negativa entre o aumento das despesas e idade, sexo feminino e diagnóstico de entrada na coorte, e relação positiva para as variáveis Índice de Desenvolvimento Humano Municipal (IDH-M) e o uso de medicamentos bloqueadores do fator de necrose tumoral (ANTI-TNF). Este estudo identificou os fatores que têm impacto sobre o gasto com o tratamento medicamentoso da AR. Também apontou que métodos que permitem extrair dados demográficos e de gastos de sistemas de informação administrativos podem ser ferramentas importantes na construção de estudos econômicos capazes de subsidiar as avaliações econômicas de saúde, especialmente do ponto de vista da gestão.

Abstract Rheumatoid arthritis (RA) is a chronic condition that affects about 1% of the adult population. In a historical cohort of Minas Gerais State, 11,573 RA patients registered in the Outpatient Information System (SIA) between 2008 and 2013 were identified. For this study we adopted the public funding body's perspective and the values were adjusted by the national inflation index (IPCA) of December 2015. Etanercept was the most expensive treatment. The mean cohort age was 52 years old and most of the patients were women. Multiple regression analysis indicated a negative association between higher expenditure and age, female sex, and diagnosis at entry in the cohort and positive association between high expenditure and the Human Development Index (HDI) of the municipality and use of tumor necrosis factor agents. This study identified the factors that have an impact on RA drug treatment expenditure. Also, we showed that methods that enable extracting demographic and expenditure data of administrative information systems may represent important tools in the construction of economic studies to subsidize economic health evaluations, especially from the standpoint of the managers.

Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil.

OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. Moreover, regimens containing cyclosporine were more cost-effective [corrected].

Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil / Análise de custo-efetividade: ciclosporina versus tacrolimo para transplante renal no Brasil

OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. However, regimens containing cyclosporine were more cost-effective. .

OBJETIVO Analisar custo-efetividade de regimes terapêuticos com ciclosporina ou tacrolimo cinco anos após transplante renal. MÉTODOS Análise de custo-efetividade com base em dados de coorte histórica 2000-2004, com 2.022 pacientes tratados com ciclosporina ou tacrolimo e pareados 1:1 segundo sexo, idade, tipo e ano de transplante. A sobrevida do enxerto e os custos diretos de cuidados médicos a partir das bases de dados do Sistema Único de Saúde foram utilizados como medida de resultado. RESULTADOS A maioria dos pacientes era do sexo feminino e média de idade de 36,6 anos. O diagnóstico mais frequente de insuficiência renal crônica foi a glomerulonefrite/nefrite (27,7%). Em cinco anos, o grupo tacrolimo obteve uma expectativa de vida média de 3,96 anos de vida ganhos ao custo anual de R$78.360,57 ante 4,05 anos de vida ganhos e de R$61.350,44 para ciclosporina. CONCLUSÕES Após o pareamento, o estudo não mostrou melhor sobrevida dos pacientes com regimes que usam tacrolimo. Além disso, regimes contendo ciclosporina foram mais custo-efetivos. .

[Use of medicines by individuals with hypertension and diabetes in municipalities covered by the Pharmacy Network in Minas Gerais State, Brazil]. / Perfil de utilização de medicamentos por indivíduos com hipertensão arterial e diabetes mellitus em municípios da Rede Farmácia de Minas.

This article analyzes the use of medicines by individuals with hypertension and/or diabetes mellitus who received their medication through a public network of pharmacies, with a particular emphasis on gender differences. During the first two months of 2010, individuals with hypertension and/or diabetes were interviewed in half of the 64 municipalities (counties) participating in the Minas Gerais Pharmacy Network. Mean age of the 4,777 interviewees was 60.9 years, which may have contributed to the high mean number of medicines used (4.0 among women and 3.5 among men). The most frequently used drugs were those acting on the cardiovascular system (56.3%), alimentary tract and metabolism (14.9%), and nervous system (13.8%), consistent with the sample's epidemiological profile. Women and more elderly individuals tended to use more medicines. The findings show high expenditures on medicines by the interviewees and suggest the design of educational activities targeting rational use of medication.

Perfil de utilização de medicamentos por indivíduos com hipertensão arterial e diabetes mellitus em municípios da Rede Farmácia de Minas / Use of medicines by individuals with hypertension and diabetes in municipalities covered by the Pharmacy Network in Minas Gerais State, Brazil

Este trabalho descreve o perfil de utilização de medicamentos de indivíduos com hipertensão e/ou diabetes, que adquirem esses produtos por meio de uma rede pública de farmácias, com ênfase nas diferenças entre sexos. No primeiro bimestre de 2010 foram entrevistados indivíduos hipertensos e/ou diabéticos, em metade dos 64 municípios então participantes da Rede Farmácia de Minas. Os 4.777 entrevistados tinham em média 60,9 anos, fato que pode ter contribuído para a elevada média de medicamentos utilizados (4,0 entre as mulheres e 3,5 entre os homens). Os medicamentos mais frequentes foram os que atuam no sistema cardiovascular (56,3%), trato alimentar e metabólico (14,9%), sistema nervoso (13,8%) e estão de acordo com o perfil epidemiológico dos entrevistados. As mulheres, juntamente com os mais idosos destacaram-se no que diz respeito à utilização de um maior número de medicamentos. Os resultados deste estudo mostraram elevados gastos com medicamentos pelos entrevistados e sugerem o delineamento de ações educativas voltadas para o uso racional de medicamentos, entre esses indivíduos.

This article analyzes the use of medicines by individuals with hypertension and/or diabetes mellitus who received their medication through a public network of pharmacies, with a particular emphasis on gender differences. During the first two months of 2010, individuals with hypertension and/or diabetes were interviewed in half of the 64 municipalities (counties) participating in the Minas Gerais Pharmacy Network. Mean age of the 4,777 interviewees was 60.9 years, which may have contributed to the high mean number of medicines used (4.0 among women and 3.5 among men). The most frequently used drugs were those acting on the cardiovascular system (56.3%), alimentary tract and metabolism (14.9%), and nervous system (13.8%), consistent with the sample's epidemiological profile. Women and more elderly individuals tended to use more medicines. The findings show high expenditures on medicines by the interviewees and suggest the design of educational activities targeting rational use of medication.

Ciclosporina versus tacrolimus no transplante renal no Brasil: uma comparação de custos

Na perspectiva do SUS, realizou-se análise econômica sobre recursos ambulatoriais, hospitalares e medicamentos utilizados por paciente e grupo terapêutico. Foi construída coorte de 2000 a 2004, com pacientes em transplantes renais e em uso de ciclosporina ou tacrolimus, identificados por relacionamento probabilístico em registros do SUS.

Perfil demográfico e epidemiológico dos usuários de medicamentos de alto custo no Sistema Único de Saúde

O artigo descreve o perfil demográfico e epidemiológico dos pacientes atendidos pelo programa, para isso realizou-se um relacionamento probabilístico-determinístico de dados provenientes de registros do Datasus: Autorizações de Procedimentos de Alta Complexidade/Alto Custo e Sistema de Informação sobre Mortalidade.

[Expenses of the Brazilian Ministry of Health for high-cost drugs: a demographic and clinical analysis]. / Gastos do Ministério da Saúde do Brasil com medicamentos de alto custo: uma análise centrada no paciente.

OBJECTIVE: To describe the expenses of the Ministry of Health of Brazil with users of High-Cost Drug Program that began treatment between 2000-2004, according to their demographic and clinical characteristics. METHODS: We made a probabilistic-deterministic linkage of national databases of drugs and mortality, resulting in a historical cohort of patients using high-cost medications in 2000-2004. The per capita spending on medicines were stratified by a follow-up period and described according to demographic, clinical and type of drug used. RESULTS: The total population atended by the program was 611,419, being 63.5% female, average age 46 years. 41.9% of patients living in the Southeast and 29.7% in the Northeast of Brazil. 24.5% of patients began treatment in 2000, 12.4% in 2001, with increasing trend until 2004. The most prevalent diagnosis referred to the genitourinary system diseases and the most common use of chemical groups were antianemic preparations. 40,941 deaths were detected (6.7% of total). The total expenditure per capita was R$4.794,34. Higher spending per capita was observed in males, aged 47, who lived in the Southeast of Brazil and began treatment in 2000, had diagnoses of infectious and parasitic diseases and used blood substitutes and perfusions solutions. CONCLUSION: The understanding of the expenses involved subsidizes restructuring actions and scheduling drug programs, also provides information for therapeutic groups which are priorities for analysis.

Gastos do Ministério da Saúde do Brasil com medicamentos de alto Custo: uma análise centrada no paciente / Expenses of the Brazilian Ministry of Health for high-cost drugs: a demographic and clinical analysis

Objective:To describe the expenses of the Ministry of Health of Brazil with users of High-Cost Drug Program that began treatment between2000 –2004, according to their demographic and clinical characteristics.Methods:We made a probabilistic-deterministic linkage of nationaldata bases of drugs and mortality, resulting in a historical cohort ofpatients using high-cost medications in 2000 –2004. The per capitas pending on medicines were stratified by a follow-up period and de-scribed according to demographic, clinical and type of drug used. Results: The total population atended by the program was 611,419, being 63.5% female, average age 46 years. 41.9% of patients living in the Southeast and 29.7% in the North east of Brazil. 24.5% of patients began treatment in 2000, 12.4% in 2001, with increasing trend until 2004. The most prevalent diagnosis referred to the genitourinary system diseases and the most common use of chemical groups were antianemic prep-arations. 40,941 deaths were detected (6.7% of total). The total expen-diture per capita was R$4.794,34. Higher spending per capita was observed in males, aged 47, who lived in the Southeast of Brazil and began treatment in 2000, had diagnoses of infectious and parasitic diseases and used blood substitutes and perfusions solutions. Conclusion: Theunder standing of the expenses involved subsidizes restructuring actions and scheduling drug programs, also provides information for therapeutic groups which are priorities for analysis.

Medicamentos excepcionais para doença renal crônica: gastos e perfil de utilização em Minas Gerais, Brasil

No Brasil, os medicamentos para o tratamento da doença renal crônica são disponibilizados gratuitamente pelo Sistema Único de Saúde (SUS). O estudo descreve os gastos públicos com esses medicamentos em Minas Gerais, Brasil, e o perfil dos usuários.

[Dispensing of exceptional drugs for chronic renal failure: expenditures and patients' profile in Minas Gerais State, Brazil]. / Medicamentos excepcionais para doença renal crônica: gastos e perfil de utilização em Minas Gerais, Brasil.

In Brazil, medicines for treatment of chronic renal failure are available free of cost from the Unified National Health System (SUS). This study's objectives were to describe government spending on these drugs in Minas Gerais State, Brazil, and the patients' profile, as well as to analyze the factors associated with individual average monthly costs. Spending on medication for chronic renal failure (R$ 41.6 million, or U$25 million) represents a significant portion of total spending on outpatient procedures in the National health System (9.6%). Most patients are young adult males with arterial hypertension as the main cause of chronic renal failure. Multivariate analysis showed a trend towards lower spending on elderly patients, those with diabetes as the main underlying disease, those using iron hydroxide, and in municipalities with a lower human development index, or HDI (p < 0.05). Finally, the study indicated the importance of management tools that allow monitoring the trajectory of individual patients in the health system and support appropriate health policymaking.

Medicamentos excepcionais para doença renal crônica: gastos e perfil de utilização em Minas Gerais, Brasil / Dispensing of exceptional drugs for chronic renal failure: expenditures and patients' profile in Minas Gerais State, Brazil

No Brasil, os medicamentos para o tratamento da doença renal crônica são disponibilizados gratuitamente pelo Sistema Único de Saúde (SUS). Este estudo teve como objetivos descrever os gastos públicos com esses medicamentos em Minas Gerais, Brasil, e o perfil dos usuários; objetivou, também, analisar os fatores associados ao gasto médio mensal individual. Observou-se que o gasto total com os medicamentos estudados (R$ 41,6 milhões) representa uma parcela significativa do gasto total com procedimentos ambulatoriais no SUS (9,6 por cento). A maioria dos usuários é do sexo masculino, adultos jovens e teve como causa principal de doença renal crônica a hipertensão arterial. A análise multivariada indicou tendência de menor gasto entre indivíduos que eram mais idosos, que tinham como causa principal da doença o diabetes, que fizeram uso de hidróxido de ferro e que residiam em municípios de menor IDH-M (p < 0,05). Finalmente, o estudo indicou a importância de ferramentas gerenciais que permitam visualizar a trajetória dos pacientes no sistema de saúde, as quais sejam capazes de subsidiar o processo de formulação de políticas de saúde.

In Brazil, medicines for treatment of chronic renal failure are available free of cost from the Unified National Health System (SUS). This study's objectives were to describe government spending on these drugs in Minas Gerais State, Brazil, and the patients' profile, as well as to analyze the factors associated with individual average monthly costs. Spending on medication for chronic renal failure (R$ 41.6 million, or U$25 million) represents a significant portion of total spending on outpatient procedures in the National health System (9.6 percent). Most patients are young adult males with arterial hypertension as the main cause of chronic renal failure. Multivariate analysis showed a trend towards lower spending on elderly patients, those with diabetes as the main underlying disease, those using iron hydroxide, and in municipalities with a lower human development index, or HDI (p < 0.05). Finally, the study indicated the importance of management tools that allow monitoring the trajectory of individual patients in the health system and support appropriate health policymaking.

[Cyclosporine versus tacrolimus in kidney transplants in Brazil: a cost comparison]. / Ciclosporina versus tacrolimus no transplante renal no Brasil: uma comparação de custos.

In Brazil, the Unified National Health System (SUS) is responsible for the majority of kidney transplants. To maintain these interventions, the guidelines recommend the use of cyclosporine or tacrolimus, associated with corticosteroids and azathioprine or mycophenolate. Taking the perspective of the National Health System, an economic analysis was performed on the outpatient and hospital resources and medicines used by patient and therapeutic group. A cohort was constructed from 2000 to 2004, with 5,174 kidney transplant patients in use of cyclosporine or tacrolimus, identified by probabilistic record linkage from the National Health System. The cohort included 4,015 patients in use of cyclosporine and 1,159 using tacrolimus. The majority were males, age < 38 years, with nephritis, cardiovascular diseases, and indeterminate causes as the most frequent primary diagnoses. After 48 months of follow-up, the expenditures were higher for kidney transplants in hospitals in the Northeast, cadaver donors, patients in dialysis > 24 months before the transplant, and in the tacrolimus group. Total hospital and outpatient costs and expenditure on medication were higher in patients on tacrolimus as compared to the cyclosporine group.

Ciclosporina versus tacrolimus no transplante renal no Brasil: uma comparação de custos / Cyclosporine versus tacrolimus in kidney transplants in Brazil: a cost comparison

No Brasil, o Sistema Único de Saúde (SUS) é responsável maioria dos transplantes renais. Para a manutenção dessas intervenções, os protocolos recomendam uso da ciclosporina ou tacrolimus, associado com corticosteróides e azatioprina ou micofenolato. Na perspectiva do SUS, realizou-se análise econômica sobre recursos ambulatoriais, hospitalares e medicamentos utilizados por paciente e grupo terapêutico. Foi construída coorte de 2000 a 2004, com 5.174 pacientes em transplantes renais e em uso de ciclosporina ou tacrolimus, identificados por relacionamento probabilístico em registros do SUS. A coorte continha 4.015 pacientes em uso de ciclosporina e 1.159 com tacrolimus. A maioria era do sexo masculino, idade < 38 anos, cujos diagnósticos primários mais freqüentes eram nefrites, doenças cardiovasculares e causas indeterminadas. Após 48 meses, observou-se gasto superior para transplantes renais em hospitais do Nordeste, doador cadáver, naqueles em diálises > 24 meses antes do transplantes renais e no grupo do tacrolimus. Constatou-se maior gasto total com recursos hospitalares, ambulatoriais e medicamentos para os transplantes renais em pacientes com esquemas com tacrolimus, quando comparados com o grupo da ciclosporina.

In Brazil, the Unified National Health System (SUS) is responsible for the majority of kidney transplants. To maintain these interventions, the guidelines recommend the use of cyclosporine or tacrolimus, associated with corticosteroids and azathioprine or mycophenolate. Taking the perspective of the National Health System, an economic analysis was performed on the outpatient and hospital resources and medicines used by patient and therapeutic group. A cohort was constructed from 2000 to 2004, with 5,174 kidney transplant patients in use of cyclosporine or tacrolimus, identified by probabilistic record linkage from the National Health System. The cohort included 4,015 patients in use of cyclosporine and 1,159 using tacrolimus. The majority were males, age < 38 years, with nephritis, cardiovascular diseases, and indeterminate causes as the most frequent primary diagnoses. After 48 months of follow-up, the expenditures were higher for kidney transplants in hospitals in the Northeast, cadaver donors, patients in dialysis > 24 months before the transplant, and in the tacrolimus group. Total hospital and outpatient costs and expenditure on medication were higher in patients on tacrolimus as compared to the cyclosporine group.

Perfil demográfico e epidemiológico dos usuários de medicamentos de alto custo no Sistema Único de Saúde / Perfil demográfico y epidemiológico de los usuarios de medicamentos de costo elevado en el Sistema Único de Salud / Epidemiological profile of high cost medicines users in the Brazilian Health System

O Programa de Medicamentos Excepcionais, do Ministério da Saúde, provê, ao tratamento de doenças, medicamentos de alto valor unitário, ou que, em caso de uso crônico ou prolongado, configurem um tratamento de custo elevado. Com o objetivo de descrever o perfil demográfico e epidemiológico dos pacientes atendidos pelo programa, realizou-se um relacionamento probabilístico-determinístico de dados provenientes de registros do Datasus: Autorizações de Procedimentos de Alta Complexidade/Alto Custo (Apac/SIA) e Sistema de Informação sobre Mortalidade (SIM). A coorte formada pelo pareamento das bases de dados identificou 611.419 indivíduos que iniciaram o tratamento no período de 2000-2004. As análises foram desagregadas por sexo, região de residência, diagnósticos e medicamentos mais utilizados. A construção desta coorte histórica propiciou a descrição das características demográficas, epidemiológicas e de utilização de medicamentos dos usuários do programa. Além disso, o banco de dados gerado viabiliza uma série de análises específicas por doenças, que podem contribuir para avaliações de efetividade e eficiência de alternativas terapêuticas constantes nos protocolos clínicos, com o objetivo de fornecer subsídios aos tomadores de decisão no que tange ao planejamento das ações e oferta de medicamentos de alto custo pelo SUS.

El Programa de Medicamentos Excepcionales del Ministerio de Salud tiene como objetivo satisfacer la demanda de medicamentos de alto valor unitario, o de aquellos empleados en enfermedades crónicas que impliquen un tratamiento de costo elevado. Con el objetivo de describir el perfil demográfico y epidemiológico de los pacientes incluidos en el programa, se realizó una vinculación probabilística-determinística de datos provenientes de registros del DATASUS (Banco de Datos del Sistema Único de Salud): Autorizaciones de Procedimientos de Alta Complejidad/Alto Costo (Apac/SIA) y Sistema de Información sobre Mortalidad (SIM). La cohorte formada a partir de la vinculación de las bases de datos identificó a 611.419 individuos que comenzaron el tratamiento en el período 2000-2004. Los análisis se han separado por sexo, región de residencia, diagnóstico y medicamentos más utilizados. La construcción de esta cohorte histórica permitió la descripción de las características demográficas, epidemiológicas y de utilización de medicamentos de los usuarios del programa. Además, el banco de datos generado hace posible la realización de una serie de análisis específicos para determinación de enfermedades, que pueden contribuir a evaluaciones de eficacia y eficiencia de las alternativas terapéuticas incluidas en los protocolos clínicos, con el objetivo de proporcionar subsidios a quienes toman decisiones con respecto a la planificación de las acciones y la oferta de medicamentos de alto costo por parte del SUS.

The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministry's databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the program's users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.

[Efficacy of interferon (conventional, pegylated) and lamivudine for treatment of chronic hepatitis B: a systematic review]. / Revisão sistemática da eficácia do interferon alfa (convencional, peguilado) e lamivudina para o tratamento da hepatite crônica B.

Chronic hepatitis B is considered a major public health problem, and its treatment entails increasing health budget expenses with high-cost drugs covered by Unified National Health System. The objective of this study was to compare the efficacy of interferon (conventional; pegylated - PEG2a) and lamivudine (LAM) for the treatment of chronic hepatitis B through a systematic review, selecting randomized, controlled clinical trials identified in PubMed and LILACS. Target outcomes were virological, biochemical, and histological response, seroconversion, and adverse effects. The review selected 35 articles. Presence or absence of HBeAg and pre-treatment alanine aminotransferase (ALT) levels were considered important factors in the initial therapeutic indication. Treatment with conventional interferon enables lasting disease inactivation and can result in HBsAg seroconversion. PEG2a showed better efficacy than interferon and LAM and similar side effects to interferon. LAM presents advantages such as its sensitivity in the HbeAg-negative phenotype, while its main disadvantage is the development of resistance.

Revisão sistemática da eficácia do interferon alfa (convencional, peguilado) e lamivudina para o tratamento da hepatite crônica B: [revisão] / Efficacy of interferon (conventional, pegylated) and lamivudine for treatment of chronic hepatitis B: a systematic review: [review]

A hepatite crônica B constitui um grave problema de saúde pública e vem demonstrando crescentes gastos com financiamento de medicamentos de dispensação em caráter excepcional e de alto custo no Sistema Único de Saúde (SUS). O objetivo do estudo foi comparar a eficácia do interferon (convencional; peguilado - PEG2a) e lamivudina (LAM) para o tratamento da hepatite crônica B, pelo método de revisão sistemática selecionando ensaios clínicos randomizados e controlados identificados nas bases PubMed e LILACS. As medidas de resultado consideradas foram resposta virológica, soroconversão, resposta bioquímica, resposta histológica e efeitos adversos. Foram selecionados 35 artigos. A presença ou ausência do HBeAg e os níveis de alanina amino transferase (ALT) no pré-tratamento demonstraram papel fundamental na indicação terapêutica inicial. O tratamento com interferons convencionais permite a inativação da doença por longos períodos de tempo, podendo resultar em soroconversão HBsAg. O PEG 2a demonstrou eficácia superior ao interferon e LAM e efeitos colaterais semelhantes ao interferon. A LAM apresenta vantagem de ser sensível para os pacientes HBeAg negativo e apresenta como maior desvantagem o desenvolvimento de resistência.

Chronic hepatitis B is considered a major public health problem, and its treatment entails increasing health budget expenses with high-cost drugs covered by Unified National Health System. The objective of this study was to compare the efficacy of interferon (conventional; pegylated - PEG2a) and lamivudine (LAM) for the treatment of chronic hepatitis B through a systematic review, selecting randomized, controlled clinical trials identified in PubMed and LILACS. Target outcomes were virological, biochemical, and histological response, seroconversion, and adverse effects. The review selected 35 articles. Presence or absence of HBeAg and pre-treatment alanine aminotransferase (ALT) levels were considered important factors in the initial therapeutic indication. Treatment with conventional interferon enables lasting disease inactivation and can result in HBsAg seroconversion. PEG2a showed better efficacy than interferon and LAM and similar side effects to interferon. LAM presents advantages such as its sensitivity in the HbeAg-negative phenotype, while its main disadvantage is the development of resistance.