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ABSTRACTObjectivesBiologics are a class of medicines recommended by UK and international guidelines for treatment of patients with rheumatoid arthritis (RA) who are unresponsive, intolerant or who have contraindications to conventional therapies. Biologics are often supplied in the UK to patients in their home by external healthcare providers commissioned by the National Health Service (NHS). Patient adherence and persistence to biologics has not been assessed within NHS Scotland.The aim of this study was to evaluate adherence and persistence patterns of subcutaneous biologics delivered by homecare services to patients with rheumatoid arthritis in a Scottish NHS Board.
ApproachA population-based cohort study was conducted using records from patients receiving medication through healthcare delivery companies in the NHS Greater Glasgow and Clyde health board. RA patients with deliveries between 2012- 2015 were linked via their Community Health Index number to their prescriptions in primary care, hospital admissions and death records. For this study those with at least two deliveries of biologics and who did not switch biologic treatment were included. Length of therapy was determined from first delivery to last day treatment was covered. Adherence rate referring to the supply received for the whole study period was evaluated through Medication Refill Adherence (MRA). Persistence from first delivery to discontinuation was estimated using survival analysis and a drug–free interval of 90 days.
ResultsA total of 434 patients with RA received a subcutaneous biologic. The mean age at first delivery was 54.7 (SD 13.4) years and 78% were female. From this cohort, 322 had at least 2 deliveries of the same biologic. The overall median length of treatment was 387.5 days (IQR 544.5); the longest for certolizumab pegol users with a median of 511.5 days (IQR 629.2) and the shortest for tocilizumab (median of 187 days, IQR 90.5). The adherence throughout the study had a mean MRA 79.73% (SD 29.95) and was similar across the different biologics. Persistence at follow-up decreased with time from 81% of the patients receiving a biologic at 6 months, to 67% after 1 year and 65% after two years. Adalimumab, certolizumab pegol, etanercept and golimumab users had higher persistence rates.
ConclusionLength of treatment and persistence, but not adherence, are influenced by the type of subcutaneous biologic received by the RA patients in this cohort.Future research will gain a better insight into the factors influencing adherence and persistence to these medicines.

IntroductionIn Brazil, the National Health System (SUS) provides healthcare to the public. The system hasmultiple administrative databases; the major databases record hospital (SIH) and outpatient (SIA)procedures. Epidemiological information is collected for all populations in subsystems, such as mor-tality (SIM), live births (SINASC) and diseases of compulsory declaration (SINAN). Each subsystemhas its own information system, which is able to provide information about consultations, clinicalinformation and medicines dispensed. However, these systems are not linked, thereby preventingindividual-centred analysis.
ObjectiveTo describe the methods and results of parameter setting that are needed to execute the probabilisticdeduplication of large administrative and epidemiological databases in Brazil and to create a NationalHealth Database Centred on the individual.
MethodsThis paper shows the results of a record linkage model to integrate data from SIH, SIA, SIM, andSINAN, which have different formats and attributes between them and over time. These data consistof 1.3 billion records from 2000-2015. Probabilistic and deterministic record linkages were used todeduplicate these data. The Kappa statistic and clerical review were used to ensure the quality ofthe linkage. The graph algorithm and depth-first search were used to generate the identifiers.
ResultsThe deterministic deduplication process resulted in a database with 403,113,527 possible uniqueindividuals. After the probabilistic deduplication process of the former database was performed,159,703,805 unique individuals were identified. This result had an estimated a false positive errorrate of 3.3%, and the false negative error was estimated at 12.3%.
ConclusionsThe National Health Database centred on the individual was generated and will allow researchersto use real-world evidence to conduct clinical, epidemiological, economic and other studies. Thisdatabase represents a significant cohort, spanning 15 years of historical data and preserving patientprivacy. The success of the process described will allow repeating and appending the data for futureyears and enable important studies to promote SUS efficiency and provide better treatments forpatients.
KeywordsData linkage, record linkage, Brazilian health database, SUS deduplication