AB0341 Experience of tocilizumab usage in chronic renal insufficiency stipulated by aa-amyloidosis due to rheumatoid arthritis complication

Abstract

Background Uremia stipulated by AA-amyloidosis is one of basic lethal causes in rheumatoid arthritis (RA) pts in Russia. Methods RA pts resistant to earlier therapy with chronic renal insufficiency, stipulated by morphologically confirmed AA-amyloidosis. Tocilizumab in dosage of 8mg/kg of body weight was administrated iv every 4 weeks for the period of observation, with regular control of integral index DAS28, creatinin clearance (ml/min), amyloid A (mg/l), proteinuria (g/24Hr). Results The study included 5 RA pts – women with medial age of 56.6±1.8 years, medial arthritis duration 18.8±5.5 with morphologically confirmed AA-amyloidosis (bioptates: kidneys -1 pt, duodenal mucous – 4 pts), with moderate renal function insufficiency: creatinin clearance (CrCl) – 36.0±3.7 ml/min, active inflammatory process – averagely DAS28was equal to 5.8±0.8, median amyloid A 61.3±19.2. Disease modifying anti-rheumatic drugs (DMARD) applied earlier to all pts – Metotrexate, Leflunomide and three of them –FNO-a - Infliximab, Humira, were withdrawn due to inefficacy or unfavorable reactions. Average period of Tocilizumab therapy was 7 months (10 months – 1, 7 months – 3, 4 months – 1 pt). At the end of observation the following indices were seen: CrCl increase to 49.2±6.7, SAA decrease 18.8±10.2 and DAS28 index – 3.2±0.8 (p<0.005). Proteinuria was considerably diminished in 2 and disappeared in 1 pts. There were no adverse effects, requiring withdrawal of Tocilizumab. Conclusions Our experience allows us to discuss the expedience of Tocilizumab usage in chronic renal insufficiency, stipulated by AA-amyloidosis, complicating RA and resistant to traditional DMARD and FNO-a inhibitors. Disclosure of Interest None Declared