Tocilizumab-induced immunocomplex glomerulonephritis: a report of two cases

Fukaya, Daichi; Inoue, Tsutomu; Kogure, Yuta; Kajiyama, Hiroshi; Ishizawa, Keisuke; Seto, Takeru; Hasegawa, Hajime; Mimura, Toshihide; Okada, Hirokazu

doi:10.1007/s13730-020-00478-6

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…In seven cases, all in patients treated with rituximab, IGD appeared within the first month of treatment, whereas in four cases (16.0%) IGDs had a long latency onset, and renal disorders developed after 2 years of treatment. Seven of the 25 patients were classified as affected by GNSV (Table 1 ) [ 18 – 22 ], seven as affected by IARD (Table 2 ) [ 23 – 28 ] and 11 as affected by GNLS (Table 3 ) [ 29 – 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…The case causality assessment for IGD identified three cases classified in the “certain” category (one with tofacitinib in GNSV and one each with certolizumab and tocilizumab in IARD) [ 21 , 24 , 28 ] and five cases classified as “probable” (one each with infliximab, adalimumab, abatacept, tocilizumab in IARD; one with ustekinumab in GNLS), with evidence for an etiologic role for biologics and JAKi in inducing IGD [ 23 , 26 – 28 , 33 ] (see Tables 1 , 2 , 3 ). The majority of cases showed weaker evidence of causality between biologic treatment and IGD development (see Tables 1 , 2 , 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Biologics and Targeted Synthetic Drugs Can Induce Immune-Mediated Glomerular Disorders in Patients with Rheumatic Diseases: An Updated Systematic Literature Review

et al. 2021

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Objective Our objective was to update the understanding of the development of paradoxical immune-mediated glomerular disorders (IGDs) in patients with rheumatic diseases treated with biologics and targeted synthetic drugs (ts-drugs). Methods A systematic literature review was performed by searching PubMed for articles published between 1 January 2014 and 1 January 2020 reporting on the development of IGD in adult patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or systemic lupus erythematosus (SLE) who were receiving biologics or ts-drugs. IGDs were classified on the basis of clinical, laboratory and histopathological data as (1) glomerulonephritis associated with systemic vasculitis (GNSV), (2) isolated autoimmune renal disorder (IARD) or (3) glomerulonephritis in SLE and in lupus-like syndrome (GNLS). The World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system for standardized case causality assessment was applied to evaluate the causal relationship between IGD and specific drugs. The classification was based on a six-category scale, where the “certain” and “probable” categories were deemed clinically relevant relationships. Results The literature search retrieved 875 articles. Of these, 16 articles reported IGD data, for a total of 25 cases. According to the WHO-UMC assessment, the strength of the causal relationship between IGDs and investigated drugs was higher for anti-tumor necrosis factor-α agents (a clinically relevant relationship was found in four of six cases), abatacept (one of two cases), tocilizumab (two cases), ustekinumab (one case) and tofacitinib (one case) than for rituximab (nine cases), belimumab (three cases) or secukinumab (one case), which showed a weak causal relationship with these paradoxical events. No cases associated with apremilast or baricitinib were found. The retrieved cases were classified as 11 GNLS, seven IARD and seven GNSV. Conclusions Biologics and ts-drugs can cause IGDs. These events are rare, and the causative effect of a specific drug is hard to establish. When a patient is suspected of having an IGD, the drug should be discontinued, and treatment for the new-onset renal disorder should be promptly started.

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