P1249Analysis of 2020–2024 prescription trends of adalimumab for crohn’s disease in Brazil

Background Adalimumab, a monoclonal anti-TNF antibody, has long been a cornerstone in Crohn’s disease (CD) management, offering durable remission and mucosal healing (1,2). However, evolving therapeutic landscapes and policy adaptations may have reshaped its utilisation pattern in Brazil’s public health system. Analysing national dispensing trends provides insight into therapeutic transitions, healthcare equity, and policy performance within the Unified Health System (SUS) (3–5). Methods Administrative records of adalimumab dispensations for Crohn’s disease (ICD-10 K50*) were obtained from the DATASUS public database for 2020–2024 (6). Data were filtered for diagnostic accuracy, cleaned for duplicates, and harmonised by region. Analyses were conducted using Python and R. Annual totals, year-on-year (YoY) variation, rate ratios (RRs) with 95% Poisson confidence intervals (CIs), and compound annual growth rate (CAGR) were calculated. The Gini coefficient was applied to assess regional inequality in drug distribution. Results Total national dispensations decreased progressively after 2021, revealing a downward trajectory across consecutive years. The peak utilisation occurred between 2021 and 2022, followed by gradual decline in 2023–2024. Rate ratios showed sequential reductions (2022 vs 2021: 0.93, 95% CI 0.90–0.96; 2023 vs 2022: 0.89, 95% CI 0.86–0.93; 2024 vs 2023: 0.84, 95% CI 0.80–0.89). The cumulative CAGR for 2020–2024 indicated a net decrease of approximately 16%. Boxplots demonstrated contraction in inter-state variability, whereas heatmaps highlighted consistent declines across most regions after 2022. The Gini coefficient remained moderate (0.38 in 2024), suggesting stable but persistent inequality in biologic access. Conclusion The national decline in adalimumab use indicates a therapeutic transition rather than reduced access. This downward trend likely reflects diversification toward newer biologics and small-molecule agents such as vedolizumab, ustekinumab, and upadacitinib (7–10). Updated clinical guidelines now emphasise personalised, mechanism-based selection, gradually displacing anti-TNF monotherapy as first-line therapy (11–13). Enhanced pharmacovigilance and renewal criteria may also have curtailed long-term continuation (14,15). While inequality indices remained moderate, persistent regional gaps mirror the concentration of IBD reference centres in wealthier areas (16,17). Despite limitations inherent to administrative data, consistent reductions across analytical models support a nationwide shift in Crohn’s disease management. Continued monitoring incorporating clinical outcomes and patient-level registries remains vital to sustain equitable, evidence-based biologic access within the SUS framework (18–20). References: 1. 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