1 Výskumný ústav reumatických chorob, Pieštany
² Farmaceutická fakulta Univerzity Komenského, Bratislava

Slovak version

Summary

Objective: The aim of our study was to find the pharmaco-economic relations in the treatment of resistant forms of rheumatoid arthritis (RA) with methotrexate (MTX) and cyclosporin A (CyA).
Methods: In 680 RA patients treated with both MTX and the combinations of MTX and other basal drugs and in the group of patients treated with both CyA and combinations of CyA+MTX as well as with other combinations, socio-economic relations were monitored (basal treatment costs, costs for laboratory tests performed during hospitalisation and specification of patients and disabled people ratio in the economic loss).
Main results: Treatment of severe forms of RA with both MTX mono-therapy or its combination with other basal drugs is the first choice for its pharmaco-economic and sociologic benefits. However, this therapy does not always manage to suppress the RA activity. Resistance to MTX shall thus lead to the second choice drug - CyA. In 1990 - 1996, the costs for CyA for 95 patients were SK 13,516,000 (USD 409,585).
Treatment of the active RA forms with MTX (585 patients) in the same period amounted to SK 345,840 (USD 10,480.40). That is why alternative treatment should be looked for. These days, combinations with MTX: MTX and gold salts (SK 1742.40, USD 52.80), MTX+ sulphasalazine (SK 6537.30, USD 198.10), MTX a chloroquine phosphate (SK 1026.30, USD 31.10), MTX+penicillamine (SK 6939.90, USD 210.30), MTX+chloroquine phosphate+gold salts (SK 2178.0, USD 66.0) are utilised in treatment. The combinations manage to decrease the number of RA forms resistant to MTX itself. From both pharmaco-economic and therapeutic point of view it would be desirable to introduce CyA treatment not after the failure of MTX itself, but only after the above mentioned combinations fail. It follows that, treatment with the combinations should be maintained as long as possible, complemented by hydrolytic enzymes (Wobenzym SK 9484.20, USD 287.40). Hydrolytic enzymes not only increase the efficacy of MTX, but also decrease the frequency of MTX side effects. Pharmaco-economic criteria advocate for the strict selection of patient treated with CyA.
Our results show that, management of high costs for CyA treatment requires early diagnostics of RA as well as setting prognostic limits to therapy-resistant forms of RA.
The advantage of this approach lies in using either CyA+MTX combination or the combination with other basal drugs if RA activity fails to he suppressed.
Changes in social status of RA patients induced by the average income loss remains an open question, augmented by the personal costs increase due to disease-related limitations and restricted approach to other sources of income.
Conclusion: Pharmaco-economic relations in resistant RA forms attract attention and indicate that, CyA treatment is usually efficient, but financially highly demanding. This aspect should be considered and CyA therapy introduced only when previous basal anti-inflammatory drugs treatment including MTX and its combination fail.
Key words: Rheumatoid arthritis, pharmaco-economics, social impacts, basal treatment, methotrexate, cyclosporin A.