Cuidado farmacêutico em pacientes com artrite reumatoide

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disease whose management involves complex therapies, often associated with polypharmacy and drug-related problems. The involvement of pharmacists within the multidisciplinary healthcare team may enhance the effectiveness and safety of treatment. Therefore, the objective of this study was to evaluate the effect of pharmaceutical care on patients with RA. This study was conducted in three complementary stages. Initially, a systematic review was performed to address the central question: “What is the effect of pharmaceutical care in patients with RA, and how is this care being delivered?” The protocol was registered in PROSPERO (CRD42020133705). Subsequently, a pilot randomized controlled trial (RCT), approved by the research ethics committee and registered under number RBR-8494rf7, was conducted to evaluate the effect of pharmaceutical care in patients with RA attending a rheumatology outpatient clinic in Brazil. Finally, considering that approximately 25% of patients with RA have renal impairment, the third stage consisted of a systematic review on the pharmacokinetics and dose adjustment of antimicrobials in patients undergoing renal replacement therapy (RRT). This protocol was also registered in PROSPERO (CRD42024532462). The systematic review on pharmaceutical care in patients with RA identified a total of 3,078 titles. Six met the predefined criteria and were included, comprising a total of 337 patients with RA. All six RCTs presented some limitations, and only one was classified as having a low risk of bias. In 66.6% of these studies, the intervention consisted of a short-term service focused on health education. When the intervention was remote and short-term, improvements in pharmacotherapy adherence reached up to 8% (P < 0.05). In contrast, when a comprehensive pharmacotherapeutic follow-up service was provided, adherence improved by up to 59% (p=0.002). Pharmaceutical interventions were also associated with significant improvements in beliefs about medicines, patient satisfaction, reductions in drug-related problems, and treatment costs. In the RCT conducted in the second stage, a total of 14 patients with RA were included, with seven allocated to each group. The medication review service, delivered by pharmacists using a hybrid model, demonstrated a statistically significant benefit for the intervention group compared with the control group regarding pharmacotherapy adherence (p=0.041) and drug-related problems (p=0.019). No significant differences were observed in quality of life, pain, or satisfaction with care. The systematic review on antimicrobial pharmacokinetics and dosing in patients undergoing RRT identified 488 titles. Thirty-two met the predefined criteria and were included, encompassing a total of 1,641 patients. Of the 31 included studies, 22 were classified as high quality, three as moderate, and seven as low quality. Most studies indicated that dose adjustments of currently used antimicrobials are required in patients undergoing RRT to ensure effectiveness and safety. These studies recommended regular therapeutic drug monitoring to achieve therapeutic targets and reduce mortality rates. Overall, the results demonstrate that pharmaceutical care, delivered in face-to-face, remote, or hybrid formats, has a significant positive impact on patients with RA. Additionally, the findings provide important context and deeper insights into essential aspects of safer and more personalized clinical pharmacy practice for the subpopulation undergoing RRT.