A recent study has evaluated the efficacy and safety of first-line targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) in patients with rheumatoid arthritis (RA) and chronic kidney disease (CKD). This retrospective cohort study, conducted at two hospitals between 2013 and 2022, included 216 RA patients who were prescribed their first tsDMARDs. The study followed dose reduction and contraindication guidelines based on kidney function.
Patients were categorized by kidney function and tsDMARD modality, with the primary outcome being the 24-month drug retention rate. Secondary outcomes included changes in the Disease Activity Score 28-C-reactive protein (DAS28-CRP) level, prednisolone dosage, and reasons for discontinuation.
The 24-month drug retention rates varied according to the estimated glomerular filtration rate (eGFR): all tsDMARDs (46.0%, 44.1%, 47.1%), tofacitinib (55.9%, 53.3%, 66.7%), baricitinib (64.2%, 42.0%), and peficitinib (36.4%, 44.1%, 40.0%). Even in groups with lower kidney function, the drug retention rate was maintained (adjusted hazard ratio 1.14, 95% confidence interval 0.81–1.62, p=0.45). Patients experienced a significant decrease in DAS28-CRP (p<0.01) and a reduction in prednisolone dosage (p<0.01) over the 6-month period following tsDMARD initiation. However, the study noted a higher incidence of herpes zoster and deep vein thrombosis (DVT) in patients with an eGFR <30 mL/min/1.73 m², although this was not statistically significant. The findings suggest that while tsDMARDs are effective and safe for patients with RA and CKD, clinicians should be vigilant about potential risks such as herpes zoster and DVT in patients with severely impaired kidney function. Reference: Yoshimura Y et al. Efficacy and safety of first-line targeted synthetic DMARDs in rheumatoid arthritis patients with chronic kidney disease. Rheumatology. 2025;keaf050. doi:10.1093/rheumatology/keaf050. Anaya Malik | AMJ
