Analysis of the structure of use and barriers to access to biologic disease-modifying antirheumantic drugs and selective immunosuppressants in immune-mediated inflammatory rheumatic diseases in the Russian Federation

Objective: to study the structure of use of biologic disease-modifying antirheumatic drugs (bDMARDs) and selective immunosuppressants (SIs) in immune-mediated inflammatory rheumatic diseases (IMIRDs) in the Russian Federation (RF), as well as an analysis of the key barriers to ensuring access to bDMARDs and SIs. Material and methods. Analysis of the results of monitoring statistical data on the use of bDMARDs and SIs in IMIRDs for 2023–2024, provided by chief external rheumatology specialists of the constituent entities of the RF. Results and discussion. It was found that in 78 regions of the RF, bDMARD and SI therapy across all funding channels covered 47.02 thousand patients with IMIRDs (33.1 patients per 100 thousand population). The frequency of use of these drugs differs in the structure of both international nonproprietary names (INN) and nosologies, as well as in regional prescribing specifics and funding channels. In the constituent entities of the RF, the maximum and minimum values of the indicator “Provision of bDMARDs and SIs per 100 thousand population, patients” differed 15-fold. Provision of bDMARDs and SIs per 100 thousand population above the nationwide level was identified in 34 regions, whereas in 44 regions it was below. Substantial regional differences in approaches to drug provision (DP) were noted: in 37 regions of the RF, financing from budget funds predominated (average level of funding via this channel was 91%). The compulsory medical insurance (CMI) system was actively used only in 12 constituent entities, whereas in 29 mixed financing of DP prevailed. Conclusion. A positive trend is observed toward an increase in the number of patients with IMIRDs receiving bDMARDs and SIs. However, substantial regional differences in approaches to DP were demonstrated, which creates barriers to the rational use of innovative therapy. Management decisions aimed at increasing access to bDMARDs and SIs in the treatment of IMIRDs are needed.