Usage of Biological Therapy in Rheumatoid Arthritis Patients with Chronic Renal Failure: A Retrospective Study from a Single Center
Öz
Due to toxicity, most disease-modifying antirheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs) should not be administered in rheumatoid arthritis (RA) patients with chronic renal failure (CRF). Biological DMARDs are an effective RA treatment, but, their effects and safety on renal function are uncertain. Biologic therapies for RA and renal insufficiency are understudied. The study included 27 individuals with an estimating glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 for more than three months who were determined to have CRF among 700 patients with RA who used biological therapies and had regular visits between 2011 and 2018. The mean age of our patients was 63.58, and 70.37% of the patients were women. The mean duration of renal failure was 5.73±2.08 years. Renal failure was diagnosed following RA in 77.7% of the patients, with a mean time between diagnosis and renal failure of 11.52±7.35 years. The first three causes of renal failure were drug toxicity (25.9%), hypertension (HT) (25.9%), and diabetes mellitus (DM) (18.5%). Tumor necrosis factor inhibitors (TNFi) were the first and most commonly used biologic agents (66.6%). The most commonly used agent among TNFi was etanercept (44.4%). C-reactive protein (CRP) and disease activity score (DAS-28) values reduced during a median 36-month biological agent follow-up period. When creatinine and eGFR values were examined at the first and last visit, creatinine decreased and eGFR increased. In this study, in which CRF progression improved, we intended to establish the efficacy, safety, and effect of biologic therapies on renal failure progression.
Anahtar Kelimeler
Biological therapy efficacy safety renal failure rheumatoid arthritis
Kaynakça
- Kaynaklar 1. Cho S-K, Sung Y-K, Park S, Bae S-C. Etanercept treatment in rheumatoid arthritis patients with chronic kidney failure on predialysis. Rheumatol Int 2010;30(11):1519-1522.
- 2. Karie S, Gandjbakhch F, Janus N, et al. Kidney disease in RA patients: prevalence and implication on RA-related drugs management: the MATRIX study. Rheumatology (Oxford) 2008;47(3):350-354.
- 3. Helin HJ, Korpela MM, Mustonen JT, Pasternack AI. Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis. Arthritis Rheum 1995;38(2):242-247.
- 4. Makino H, Yoshinaga Y, Yamasaki Y, et al. Renal involvement in rheumatoid arthritis: analysis of renal biopsy specimens from 100 patients. Mod Rheumatol 2002;12(2):148-154.
- 5. Tokoroyama T, Ando M, Setoguchi K, Tsuchiya K, Nitta K. Prevalence, incidence and prognosis of chronic kidney disease classified according to current guidelines: a large retrospective cohort study of rheumatoid arthritis patients. Nephrol Dial Transplant 2017;32(12):2035-2042.
- 6. Hickson LJ, Crowson CS, Gabriel SE, McCarthy JT, Matteson EL. Development of reduced kidney function in rheumatoid arthritis. Am J Kidney Dis 2014;63(2):206-213.
- 7. Kapoor T, Bathon J. Renal Manifestations of Rheumatoid Arthritis. Rheum Dis Clin North Am 2018;44(4):571-584.
- 8. Matteson EL, Davis JM. Overview of the systemic and nonarticular manifestations of rheumatoid arthritis. UpToDate. https://www.uptodate.com/contents/overview-of-the-systemic-and-nonarticular-manifestations-of-rheumatoid-arthritis? Published 2021.
- 9. Stokes MB, Foster K, Markowitz GS, et al. Development of glomerulonephritis during anti-TNF-alpha therapy for rheumatoid arthritis. Nephrol Dial Transplant 2005;20(7):1400-1406.
- 10. Kim HW, Lee C-K, Cha H-S, et al. Effect of anti-tumor necrosis factor alpha treatment of rheumatoid arthritis and chronic kidney disease. Rheumatol Int 2015;35(4):727-734.
- 11. Lee S-H, Lee EJ, Chung SW, et al. Renal involvement in ankylosing spondylitis: prevalence, pathology, response to TNF-a blocker. Rheumatol Int 2013;33(7):1689-1692.
- 12. Kobak S. Efficacy and safety of adalimumab in a patient with ankylosing spondylitis on peritoneal dialysis. Rheumatol Int 2012;32(6):1785-1787.
- 13. Önen F, Can G, Çapar S, et al. A real-life analysis of patients with rheumatologic diseases on biological treatments: Data from TURKBIO Registry. Eur J Rheumatol 2022;9(2):82-87.
- 14. Karstila K, Korpela M, Sihvonen S, Mustonen J. Prognosis of clinical renal disease and incidence of new renal findings in patients with rheumatoid arthritis: follow-up of a population-based study. Clin Rheumatol. 2007;26(12):2089-2095.
- 15. Haroon M, Adeeb F, Devlin J, Gradaigh OD, Walker F. A comparative study of renal dysfunction in patients with inflammatory arthropathies: strong association with cardiovascular diseases and not with anti-rheumatic therapies, inflammatory markers or duration of arthritis. Int J Rheum Dis 2011;14(3):255-260.
- 16. Sumida K, Molnar MZ, Potukuchi PK, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int 2018;93(5):1207-1216.
- 17. Mori S, Yoshitama T, Hirakata N, Ueki Y. Prevalence of and factors associated with renal dysfunction in rheumatoid arthritis patients: a cross-sectional study in community hospitals. Clin Rheumatol 2017;36(12):2673-2682.
- 18. Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Inflammation as a Risk of Developing Chronic Kidney Disease in Rheumatoid Arthritis. PLoS One 2016;11(8):e0160225.
- 19. Fernández-Nebro A, Tomero E, Ortiz-Santamaría V, et al. Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists. Am J Med 2005;118(5):552-556.
- 20. Nakamura T, Higashi S-I, Tomoda K, Tsukano M, Shono M. Effectiveness of etanercept vs cyclophosphamide as treatment for patients with amyloid A amyloidosis secondary to rheumatoid arthritis. Rheumatology (Oxford) 2012;51(11):2064-2069.
- 21. Jung J-Y, Kim Y-B, Kim J-W, Suh C-H, Kim H-A. Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy: Case report and review of literature. Medicine (Baltimore) 2021;100(32):e26843.
- 22. Don BR, Spin G, Nestorov I, et al. The pharmacokinetics of etanercept in patients with end-stage renal disease on haemodialysis. J Pharm Pharmacol 2005;57(11):1407-1413.
- 23. Hammoudeh M. Infliximab treatment in a patient with rheumatoid arthritis on haemodialysis. Rheumatology (Oxford) 2006;45(3):357-359.
- 24. Iwamoto M, Honma S, Asano Y, Minota S. Effective and safe administration of tocilizumab to a patient with rheumatoid arthritis on haemodialysis. Rheumatol Int. 2011;31(4):559-560.
- 25. Toda M, Fujii K, Yoshifuji A, et al. Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients. Clin Exp Nephrol 2022;26(1):75-85.
- 26. Gupta S, Madhyastha R, Hamed F, et al. Tocilizumab Use in a Chronic Hemodialysis Patient for the Management of COVID-19-Associated Pneumonia and Acute Respiratory Distress Syndrome. Case reports Nephrol 2020;2020:8829309.
- 27. Hammami MB, Garibaldi B, Shah P, et al. Clinical course of COVID-19 in a liver transplant recipient on hemodialysis and response to tocilizumab therapy: A case report. Am J Transplant 2020;20(8):2254-2259.
- 28. Fukuda M, Sawa N, Hoshino J, et al. Tocilizumab preserves renal function in rheumatoid arthritis with AA amyloidosis and end-stage kidney disease: Two case reports. Clin Nephrol 2021;95(1):54-61.
- 29. Gottenberg J-E, Merle-Vincent F, Bentaberry F, et al. Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy. Arthritis Rheum 2003;48(7):2019-2024.
- 30. Okuda Y. AA amyloidosis - Benefits and prospects of IL-6 inhibitors. Mod Rheumatol 2019;29(2):268-274.
- 31. Vinicki JP, De Rosa G, Laborde HA. Renal amyloidosis secondary to rheumatoid arthritis: remission of proteinuria and renal function improvement with tocilizumab. J Clin Rheumatol 2013;19(4):211-213.
- 32. Kerola AM, Kazemi A, Rollefstad S, et al. All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study. Rheumatology (Oxford). April 2022.
- 33. Lee EE, Shin A, Lee J, et al. All-cause and cause-specific mortality of patients with rheumatoid arthritis in Korea: A nation-wide population-based study. Jt bone spine. 2022;89(1):105269.
- 34. Magnano MD, Genovese MC. Management of co-morbidities and general medical conditions in patients with rheumatoid arthritis. Curr Rheumatol Rep 2005;7(5):407-415.
- 35. Sihvonen S, Korpela M, Mustonen J, Laippala P, Pasternack A. Renal disease as a predictor of increased mortality among patients with rheumatoid arthritis. Nephron Clin Pract 2004;96(4):c107-14.
- 36. van Sijl AM, van den Oever IAM, Peters MJL, et al. Subclinical renal dysfunction is independently associated with cardiovascular events in rheumatoid arthritis: the CARRÉ Study. Ann Rheum Dis 2012;71(3):341-344.
Kronik Böbrek Hastalığı Olan Romatoid Artrit Hastalarında Biyolojik Tedavi Kullanımı: Tek Merkezli Retrospektif Çalışma
Öz
Kronik böbrek hastalığı (KBH) olan romatoid artrit (RA) hastalarında, potansiyel toksisiteleri nedeniyle hastalığı modifiye edici antiromatizmal ilaçların (DMARD) çoğunu ve steroid olmayan antiinflamatuar ilaçları (NSAİİ) kullanmak uygun değildir. Biyolojik DMARD'lar RA hastaları için oldukça etkili bir tedavi seçeneği olsa da böbrek fonksiyonları üzerindeki etkisi ve güvenilirliği tam olarak belirlenememiştir. KBH’si olan RA’lı hastalarda biyolojik tedavilerin kullanımına ilişkin veriler kısıtlıdır. 2011-2018 yılları arasında RA tanısı ile takip ettiğimiz, biyolojik ajan kullanan ve düzenli vizitleri bulunan 700 hasta arasından tahmini glomerüler filtrasyon hızı (eGFR) üç aydan uzun süredir <60 ml /dk / 1.73 m2 olan ve KBH kabul edilen 27 hasta çalışmaya dahil edildi. Hastalarımızın yaş ortalaması 63,58 idi ve hastaların %70,37'si kadındı. Ortalama renal yetmezlik süresi 5,73±2,08 yıldı. Hastaların %77,7’sinde renal yetmezlik RA tanısından sonra konmuştu ve tanı ile renal yetmezlik arasında ortalama 11,52±7,35 yıl vardı. Renal yetmezlik nedenleri arasında ilk üç sırada ilaç toksisitesi (%25,9), hipertansiyon (HT) (%25,9) ve diabetes mellitus (DM) (%18,5) bulunmaktaydı. İlk ve en sık kullanılan biyolojik ajanlar tümör nekroz faktör inhibitörleriydi (TNFi) (%66,6). TNFi arasında en fazla kullanılan ajan ise etanersept’ti (%44,4). Ortanca 36 aylık biyolojik ajan takip sürecinde C-reaktif protein (CRP) ve hastalık aktivite skoru (DAS-28) değerlerinde beklendiği üzere anlamlı düşüş gözlendi. Başlangıç ve son vizit kreatinin ve eGFR değerlendirildiğinde ise istatistik anlamlılığa ulaşmasa da kreatininde düşüş ve eGFR’de artış saptandı. KBH progresyonuna olumlu etki gördüğümüz bu çalışmada biyolojik tedavilerin KBH’li RA hastalarında kullanımının değerlendirilmesi ve renal yetmezliğin ilerlemesi üzerine olan etkisini belirlemeyi amaçladık.
Anahtar Kelimeler
Biyolojik tedavi etkinlik güvenlik renal yetmezlik romatoid artrit
Kaynakça
- Kaynaklar 1. Cho S-K, Sung Y-K, Park S, Bae S-C. Etanercept treatment in rheumatoid arthritis patients with chronic kidney failure on predialysis. Rheumatol Int 2010;30(11):1519-1522.
- 2. Karie S, Gandjbakhch F, Janus N, et al. Kidney disease in RA patients: prevalence and implication on RA-related drugs management: the MATRIX study. Rheumatology (Oxford) 2008;47(3):350-354.
- 3. Helin HJ, Korpela MM, Mustonen JT, Pasternack AI. Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis. Arthritis Rheum 1995;38(2):242-247.
- 4. Makino H, Yoshinaga Y, Yamasaki Y, et al. Renal involvement in rheumatoid arthritis: analysis of renal biopsy specimens from 100 patients. Mod Rheumatol 2002;12(2):148-154.
- 5. Tokoroyama T, Ando M, Setoguchi K, Tsuchiya K, Nitta K. Prevalence, incidence and prognosis of chronic kidney disease classified according to current guidelines: a large retrospective cohort study of rheumatoid arthritis patients. Nephrol Dial Transplant 2017;32(12):2035-2042.
- 6. Hickson LJ, Crowson CS, Gabriel SE, McCarthy JT, Matteson EL. Development of reduced kidney function in rheumatoid arthritis. Am J Kidney Dis 2014;63(2):206-213.
- 7. Kapoor T, Bathon J. Renal Manifestations of Rheumatoid Arthritis. Rheum Dis Clin North Am 2018;44(4):571-584.
- 8. Matteson EL, Davis JM. Overview of the systemic and nonarticular manifestations of rheumatoid arthritis. UpToDate. https://www.uptodate.com/contents/overview-of-the-systemic-and-nonarticular-manifestations-of-rheumatoid-arthritis? Published 2021.
- 9. Stokes MB, Foster K, Markowitz GS, et al. Development of glomerulonephritis during anti-TNF-alpha therapy for rheumatoid arthritis. Nephrol Dial Transplant 2005;20(7):1400-1406.
- 10. Kim HW, Lee C-K, Cha H-S, et al. Effect of anti-tumor necrosis factor alpha treatment of rheumatoid arthritis and chronic kidney disease. Rheumatol Int 2015;35(4):727-734.
- 11. Lee S-H, Lee EJ, Chung SW, et al. Renal involvement in ankylosing spondylitis: prevalence, pathology, response to TNF-a blocker. Rheumatol Int 2013;33(7):1689-1692.
- 12. Kobak S. Efficacy and safety of adalimumab in a patient with ankylosing spondylitis on peritoneal dialysis. Rheumatol Int 2012;32(6):1785-1787.
- 13. Önen F, Can G, Çapar S, et al. A real-life analysis of patients with rheumatologic diseases on biological treatments: Data from TURKBIO Registry. Eur J Rheumatol 2022;9(2):82-87.
- 14. Karstila K, Korpela M, Sihvonen S, Mustonen J. Prognosis of clinical renal disease and incidence of new renal findings in patients with rheumatoid arthritis: follow-up of a population-based study. Clin Rheumatol. 2007;26(12):2089-2095.
- 15. Haroon M, Adeeb F, Devlin J, Gradaigh OD, Walker F. A comparative study of renal dysfunction in patients with inflammatory arthropathies: strong association with cardiovascular diseases and not with anti-rheumatic therapies, inflammatory markers or duration of arthritis. Int J Rheum Dis 2011;14(3):255-260.
- 16. Sumida K, Molnar MZ, Potukuchi PK, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int 2018;93(5):1207-1216.
- 17. Mori S, Yoshitama T, Hirakata N, Ueki Y. Prevalence of and factors associated with renal dysfunction in rheumatoid arthritis patients: a cross-sectional study in community hospitals. Clin Rheumatol 2017;36(12):2673-2682.
- 18. Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Inflammation as a Risk of Developing Chronic Kidney Disease in Rheumatoid Arthritis. PLoS One 2016;11(8):e0160225.
- 19. Fernández-Nebro A, Tomero E, Ortiz-Santamaría V, et al. Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists. Am J Med 2005;118(5):552-556.
- 20. Nakamura T, Higashi S-I, Tomoda K, Tsukano M, Shono M. Effectiveness of etanercept vs cyclophosphamide as treatment for patients with amyloid A amyloidosis secondary to rheumatoid arthritis. Rheumatology (Oxford) 2012;51(11):2064-2069.
- 21. Jung J-Y, Kim Y-B, Kim J-W, Suh C-H, Kim H-A. Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy: Case report and review of literature. Medicine (Baltimore) 2021;100(32):e26843.
- 22. Don BR, Spin G, Nestorov I, et al. The pharmacokinetics of etanercept in patients with end-stage renal disease on haemodialysis. J Pharm Pharmacol 2005;57(11):1407-1413.
- 23. Hammoudeh M. Infliximab treatment in a patient with rheumatoid arthritis on haemodialysis. Rheumatology (Oxford) 2006;45(3):357-359.
- 24. Iwamoto M, Honma S, Asano Y, Minota S. Effective and safe administration of tocilizumab to a patient with rheumatoid arthritis on haemodialysis. Rheumatol Int. 2011;31(4):559-560.
- 25. Toda M, Fujii K, Yoshifuji A, et al. Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients. Clin Exp Nephrol 2022;26(1):75-85.
- 26. Gupta S, Madhyastha R, Hamed F, et al. Tocilizumab Use in a Chronic Hemodialysis Patient for the Management of COVID-19-Associated Pneumonia and Acute Respiratory Distress Syndrome. Case reports Nephrol 2020;2020:8829309.
- 27. Hammami MB, Garibaldi B, Shah P, et al. Clinical course of COVID-19 in a liver transplant recipient on hemodialysis and response to tocilizumab therapy: A case report. Am J Transplant 2020;20(8):2254-2259.
- 28. Fukuda M, Sawa N, Hoshino J, et al. Tocilizumab preserves renal function in rheumatoid arthritis with AA amyloidosis and end-stage kidney disease: Two case reports. Clin Nephrol 2021;95(1):54-61.
- 29. Gottenberg J-E, Merle-Vincent F, Bentaberry F, et al. Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy. Arthritis Rheum 2003;48(7):2019-2024.
- 30. Okuda Y. AA amyloidosis - Benefits and prospects of IL-6 inhibitors. Mod Rheumatol 2019;29(2):268-274.
- 31. Vinicki JP, De Rosa G, Laborde HA. Renal amyloidosis secondary to rheumatoid arthritis: remission of proteinuria and renal function improvement with tocilizumab. J Clin Rheumatol 2013;19(4):211-213.
- 32. Kerola AM, Kazemi A, Rollefstad S, et al. All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study. Rheumatology (Oxford). April 2022.
- 33. Lee EE, Shin A, Lee J, et al. All-cause and cause-specific mortality of patients with rheumatoid arthritis in Korea: A nation-wide population-based study. Jt bone spine. 2022;89(1):105269.
- 34. Magnano MD, Genovese MC. Management of co-morbidities and general medical conditions in patients with rheumatoid arthritis. Curr Rheumatol Rep 2005;7(5):407-415.
- 35. Sihvonen S, Korpela M, Mustonen J, Laippala P, Pasternack A. Renal disease as a predictor of increased mortality among patients with rheumatoid arthritis. Nephron Clin Pract 2004;96(4):c107-14.
- 36. van Sijl AM, van den Oever IAM, Peters MJL, et al. Subclinical renal dysfunction is independently associated with cardiovascular events in rheumatoid arthritis: the CARRÉ Study. Ann Rheum Dis 2012;71(3):341-344.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Romatoloji ve Artrit |
| Bölüm | Özgün Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Eylül 2022 |
| Kabul Tarihi | 22 Temmuz 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 48 Sayı: 2 |
Kaynak Göster
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