A NEW retrospective cohort study has shed light on the efficacy and safety of first-line biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) who also suffer from chronic kidney disease (CKD), including those undergoing haemodialysis (HD).
The study was conducted at two hospitals between 2004 and 2021, with 425 participants with RA, who were categorized based on their kidney function and the type of bDMARD they were prescribed, which included TNFα inhibitors (TNFαis), interleukin-6 inhibitors (IL-6is), and cytotoxic T-lymphocyte antigen-4 immunoglobulin (CTLA4-Ig). The primary outcome measured was the 36-month drug retention rate, with secondary outcomes focusing on changes in Disease Activity Score 28 (DAS28)-C reactive protein (CRP)/erythrocyte sedimentation rate (ESR), prednisolone dosage, and reasons for discontinuation.
Results showed that the 36 month drug retention rates, estimated by glomerular filtration rate (eGFR) (≥60, 30–60, <30 mL/min/1.73 m2) were as follows: all bDMARDs (45.2%, 32.0%, 41.4%), TNFαis (45.3%, 28.2%, 34.0%), IL-6is (47.4%, 66.7%, 71.4%) and CTLA-4Ig (50.0%, 31.3%, 33.3%). Notably, the retention rate of TNFαis was significantly lower in patients with severe kidney impairment (eGFR <30 mL/min/1.73 m²). On the other hand, IL-6is showed the highest retention rate and the lowest discontinuation rate due to ineffectiveness in this group (HR 0.11, 95% CI 0.02 to 0.85, p=0.03).
All bDMARDs improved DAS28-CRP/ESR scores and reduced prednisolone dosage across all groups, indicating effective disease control. The results underline the efficacy and safety of bDMARDs in RA patients with CKD, with IL-6is particularly standing out due to their higher retention rates and lower discontinuation rates due to ineffectiveness, especially in patients with severe kidney disease.
Aleksandra Zurowska, EMJ
Reference
Yoshimura Y et al. Efficacy and safety of first-line biological DMARDs in rheumatoid arthritis patients with chronic kidney disease. ARD. 2024. [Epub ahead of print].
