Usage of Biological Therapy in Rheumatoid Arthritis Patients with Chronic Renal Failure: A Retrospective Study from a Single Center

Abstract

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 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%). CRP and 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.

Factors that predict development of chronic kidney disease in patients with rheumatoid arthritis receiving biologic DMARDs and mortality rates

“…The most frequently preferred bDMARD was anti‐TNF, with etanercept leading by 44.4%. Findings regarding treatment in the present study were consistent with the above‐mentioned studies 19 . In the literature, there is a study reporting that tocilizumab is protective for renal functions 11 .…”