Abstract Background The Brazilian Policy for Comprehensive Care for People with Rare Diseases was implemented in 2014; however, national epidemiological data on rare diseases (RDs) are scarce and mainly focused on specific disorders. To address this gap, University Hospitals, Reference Services for Neonatal Screening, and Reference Services for Rare Diseases, all of which are public health institutions, established the Brazilian Rare Diseases Network (RARAS) in 2020. The objective of this study was to perform a comprehensive nationwide epidemiological investigation of individuals with RDs in Brazil. This retrospective survey collected data from patients receiving care in 34 healthcare facilities affiliated with RARAS in 2018 and 2019. Results The survey included 12,530 participants with a median age of 15.0 years, with women representing 50.5% of the cohort. Classification according to skin color demonstrated that 5044 (47.4%) participants were admixed. Most had a confirmed diagnosis (63.2%), with a predominance of phenylketonuria (PKU), cystic fibrosis (CF), and acromegaly. Common clinical manifestations included global developmental delay and seizures. The average duration of the diagnostic odyssey was 5.4 years (± 7.9 years). Among the confirmed diagnoses, 52.2% were etiological (biochemical: 42.5%; molecular: 30.9%), while 47.8% were clinical. Prenatal diagnoses accounted for 1.2%. Familial recurrence and consanguinity rates were 21.6% and 6.4%, respectively. Mainstay treatments included drug therapy (55.0%) and rehabilitation (15.6%). The Public Health System funded most diagnoses (84.2%) and treatments (86.7%). Hospitalizations were reported in 44.5% of cases, and the mortality rate was 1.5%, primarily due to motor neuron disease and CF. Conclusion This study marks a pioneering national-level data collection effort for rare diseases in Brazil, offering novel insights to advance the understanding, management, and resource allocation for RDs. It unveils an average diagnostic odyssey of 5.4 years and a higher prevalence of PKU and CF, possibly associated with the specialized services network, which included newborn screening services.

Introdução: De acordo com a Organização Mundial de Saúde, é considerada uma doença rara (DR) aquela que afeta até 65 pessoas em cada 100.000 indivíduos, sendo 80% delas com causa genética. Essas enfermidades, além de impactarem a vida do indivíduo, geram consequências clínicas, sociais e econômicas no contexto das famílias e da sociedade, como por exemplo o deslocamento para centros de referência. Existem dados limitados sobre a distância percorrida até serviços de referência por pacientes com DR. Objetivos: Conhecer a naturalidade, o local de residência e a distância percorrida pelos pacientes com diagnóstico ou suspeita de DR para atendimento no Serviço de Referência de Doenças Raras (SRDR) no Rio Grande do Sul. Metodologia: Estudo quantitativo e retrospectivo do Projeto Rede Nacional das Doenças Raras (RARAS), com dados do SRDR Hospital de Clínicas de Porto Alegre. Resultados: Dos 1026 pacientes com DR avaliados no período, 50,4% são do sexo masculino e 49,6%, do sexo feminino. Todos os pacientes nasceram no território brasileiro. Quanto à região de nascimento, a maioria nasceu na região Sul, (991, 96,7%), seguido da região Sudeste (18, 1,8%), Centro-oeste (6, 0,6%), Nordeste (6, 0,6%) e Norte (4, 0,4%). A maioria dos pacientes reside em Porto Alegre e Grande Porto Alegre (56,9%), enquanto somente 2,7% residem em outras unidades federativas, sendo as mais frequentes Santa Catarina (1,5%), Minas Gerais (0,5%) e Mato Grosso (0,2%). A distância média percorrida pelos pacientes do município de residência até o SRDR foi de 137,8±255,4 Km, sendo a maior distância 3.778,7 km (Recife) e a menor 0km (Porto Alegre). Conclusão: Pacientes com DR necessitam de atendimento especializado e multidisciplinar em sua jornada, desde o diagnóstico até o tratamento, sendo esse muitas vezes para toda vida. Apesar de a maioria dos pacientes residirem em Porto Alegre e região metropolitana, observamos um grande fluxo de pacientes de cidades do interior do Rio Grande do Sul e outros estados até a capital Porto Alegre, onde se concentram os profissionais e serviços especializados em DR. Essa distância percorrida muitas vezes interfere na jornada do paciente com DR e dificulta seu diagnóstico ou tratamento, bem como impacta na economia e qualidade de vida de seus cuidadores. Esses dados reforçam a importância de ampliar o acesso e o número de centros especializados em DR no interior do estado e também em outras regiões do país.

The Brazilian Policy of Comprehensive Care for People with Rare Diseases (BPCCPRD) was established by the Ministry of Health to reduce morbidity and mortality and improve the quality of life of people with rare diseases (RD). Several laboratory tests, most using molecular genetic technologies, have been incorporated by the Brazilian Public Health System, and 18 specialised centres have so far been established at university hospitals (UH) in the capitals of the Southern, Southeastern and Northeastern regions. However, whether the available human and technological resources in these services are appropriate and sufcient to achieve the goals of care established by the BPCCPRD is unknown. Despite great advances in diagnosis, especially due to new technologies and the recent structuring of clinical assessment of RD in Brazil, epidemiological data are lacking and when available, restricted to specifc disorders. This position paper summarises the performance of a nationally representative survey on epidemiology, clinical status, and diagnostic and therapeutic resources employed for individuals with genetic and non-genetic RD in Brazil. The Brazilian Rare Disease Network (BRDN) is under development, comprising 40 institutions, including 18 UH, 17 Rare Diseases Reference Services and fve Newborn Screening Reference Services. A retrospective study will be initially conducted, followed by a prospective study. The data collection instrument will use a standard protocol with sociodemographic data and clinical and diagnostic aspects according to international ontology. This great collaborative network is the frst initiative of a large epidemiological data collection of RD in Latin America, and the results will increase the knowledge of RD in Brazil and help health managers to improve national public policy on RD in Brazil