1
|
Yoshimura Y, Yamanouchi M, Mizuno H, Ikuma D, Koizumi R, Kurihara S, Oba Y, Suwabe T, Sawada Y, Kamido H, Sugimoto H, Mizuta M, Sekine A, Hasegawa E, Ubara Y, Sawa N. Efficacy and safety of first-line biological DMARDs in rheumatoid arthritis patients with chronic kidney disease. Ann Rheum Dis 2024:ard-2024-225914. [PMID: 38964755 DOI: 10.1136/ard-2024-225914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/29/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of first-line biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) with chronic kidney disease (CKD), including those undergoing haemodialysis (HD). METHODS This retrospective cohort study included 425 patients with RA prescribed their first bDMARDs at two hospitals from 2004 to 2021. Patients were categorised by kidney function and bDMARD modality (TNFα inhibitors (TNFαis), interleukin-6 inhibitors (IL-6is), cytotoxic T-lymphocyte antigen-4 immunoglobulin (CTLA4-Ig)). The primary outcome was the 36-month drug retention rate, with secondary outcomes including changes in Disease Activity Score 28 (DAS28)-C reactive protein (CRP)/erythrocyte sedimentation rate (ESR), prednisolone dosage and reasons for discontinuation. RESULTS The 36-month drug retention rates by estimated 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%). Even in groups with lower kidney function, the drug retention rate of bDMARDs was generally maintained. However, the retention rate of TNFαis was significantly lower in patients with eGFR <30 mL/min/1.73 m2. 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 and reduced prednisolone dosage across all groups. CONCLUSION bDMARDs demonstrated effective and safe profiles in patients with RA with CKD, even among patients on HD. In particular, IL-6is had a significantly higher drug retention rate in patients with an eGFR of <30 mL/min/1.73 m2 and fewer discontinuations due to ineffectiveness. IL-6is were more efficacious as monotherapy compared with the other bDMARDs.
Collapse
Affiliation(s)
- Yusuke Yoshimura
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Daisuke Ikuma
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Ryo Koizumi
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Shigekazu Kurihara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yuki Oba
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yuichiro Sawada
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Hisashi Kamido
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Hisashi Sugimoto
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Masato Mizuta
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Akinari Sekine
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Eiko Hasegawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| |
Collapse
|
2
|
Suetsugu R, Sakuma H, Maruyama K, Matsuki M, Ogawa Y, Nakagawa N. Successful treatment of coexisting membranous nephropathy and immune thrombocytopenia by eradicating gastric Helicobacter pylori infection: a case report. CEN Case Rep 2024; 13:98-103. [PMID: 37421572 PMCID: PMC10982251 DOI: 10.1007/s13730-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome in middle-aged and older adults. MN etiology is mainly primary or idiopathic; however, it may also be secondary to infections, drugs, neoplasms, and autoimmune diseases. We present the case of a 52-year-old Japanese man with coexisting nephrotic MN and immune thrombocytopenic purpura (ITP). Renal biopsy revealed glomerular basement membrane thickening with immunoglobulin (Ig) G and complement component 3 deposition. Glomerular IgG subclass analysis revealed predominant IgG4 deposition with weak IgG1 and IgG2 deposition. IgG3 and phospholipase A2 receptor deposits were negative. Upper endoscopy revealed no ulcers, but histological examination demonstrated Helicobacter pylori infection in the gastric mucosa with elevated IgG antibodies. After gastric Helicobacter pylori eradication, the nephrotic-range proteinuria and thrombocytopenia of the patient were markedly improved without initiation of immunosuppressive treatment. Therefore, clinicians should consider the possibility of Helicobacter pylori infection in patients with coexisting MN and ITP. Further studies are required to demonstrate the associated pathophysiological aspects.
Collapse
Affiliation(s)
- Reina Suetsugu
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Hirofumi Sakuma
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Keisuke Maruyama
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Motoki Matsuki
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan.
| |
Collapse
|
3
|
Wang XF, Duan SB, He J, Wu X, Wu T. Causal effects of rheumatoid arthritis or ankylosing spondylitis on membranous nephropathy: a two-sample Mendelian randomization study. Clin Kidney J 2023; 16:2605-2613. [PMID: 38046019 PMCID: PMC10689137 DOI: 10.1093/ckj/sfad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Membranous nephropathy (MN) is the leading cause of adult-onset nephrotic syndrome, with primary MN of unclear cause accounting for 80% of cases. Retrospective clinical research reported that MN occurring in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients was triggered by nephrotoxic drugs or of unknown cause. However, whether RA or AS itself increases the risk of developing MN is unknown. Methods We conducted mendelian randomization (MR) analysis to evaluate the causal effects of RA or AS on MN using genome-wide association study (GWAS) statistics. The inverse variance weighted (IVW) method was the primary analysis, and several supplementary analyses and sensitivity analyses were performed to test the causal estimates. Results We obtained 30 valid instrumental variables (IVs) of RA and 16 valid IVs of AS from large-scale open-access GWASs. The genetically predicted RA significantly increased the risk of MN [IVW odds ratios (OR) = 1.327, 95% confidence interval (CI) = (1.124, 1.565), P = 8.051 × 10-4]. Three supplementary MR analyses provided the consistent positive causal effect of RA on MN (all P < 0.05). No horizontal pleiotropy was detected by MR Egger intercept analysis (P = 0.411). However, the genetically predicted AS had no causal effect on MN by IVW and supplementary analysis (all P > 0.05). Conclusions Genetically predicted RA could increase the risk of MN, but genetically predicted AS was not associated with MN. Screening for kidney involvement in RA patients should be noted, and active treatment of RA will reduce the public health burden of MN.
Collapse
Affiliation(s)
- Xiu-Fen Wang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| | - Jian He
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xi Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| | - Ting Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| |
Collapse
|
4
|
de Groot K, Schreiber JG. [This is how I treat rheumatoid arthritis in dialysis patients]. Z Rheumatol 2023; 82:325-327. [PMID: 36853340 DOI: 10.1007/s00393-023-01334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Kirsten de Groot
- Medizinische Klinik 3, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland
| | - Judith G Schreiber
- Medizinische Klinik 3, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland.
| |
Collapse
|
5
|
Fukuda M, Sawa N, Ikuma D, Oba Y, Mizuno H, Yamanouchi M, Sekine A, Hasegawa E, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Tamaki H, Miyazono M, Ubara Y. Endothelial Damage-dominant Nephritis Related to IgA Vasculitis after 11 Years' Use of Infliximab for Rheumatoid Arthritis. Intern Med 2023; 62:81-85. [PMID: 35650123 PMCID: PMC9876708 DOI: 10.2169/internalmedicine.9059-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 43-year-old Japanese woman with rheumatoid arthritis treated by infliximab and methotrexate for 11 years was admitted for proteinuria and purpura. A kidney biopsy revealed endothelial damage-dominant nephritis with IgA deposition. Infliximab and methotrexate were discontinued, and tocilizumab was started; however, proteinuria persisted. Therefore, tocilizumab was discontinued, and oral prednisolone and methylprednisolone pulse therapy were administered. After 6 months, urinary protein was less than 0.1 g/day, and purpura subsided. To our knowledge, this is the first case of endothelial damage-dominant nephritis related to IgA vasculitis involving the skin and kidney after long-term use of infliximab and methotrexate.
Collapse
Affiliation(s)
- Makoto Fukuda
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hiromichi Tamaki
- Immuno-Rheumatology Center, St. Luke's International Hospital, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University Internal Medicine, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| |
Collapse
|
6
|
Yoshimura Y, Watanabe S, Yamanouchi M, Ikuma D, Mizuno H, Sekine A, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Ubara Y, Sawa N. Tocilizumab Attenuates Anti-neutrophil Cytoplasmic Antibody-associated Nephritis Occurring During Abatacept and Adalimumab Therapy for Rheumatoid Arthritis: A Case Report. Intern Med 2022. [PMID: 36418100 PMCID: PMC10400383 DOI: 10.2169/internalmedicine.0858-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We encountered an 86-year-old Japanese woman who presented with proteinuria (0.4 g/day) and hematuria (red blood cell sediment >100/high-power field), a decreased renal function (serum creatinine, 1.51 mg/dL), and elevated myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (231 IU/mL) during treatment of rheumatoid arthritis with abatacept (a CTLA-4 agent) and adalimumab (a tumor necrosis factor-α agent). A kidney biopsy showed pauci-immune necrotizing glomerulonephritis, and ANCA-associated vasculitis was diagnosed. Treatment with tocilizumab (an interleukin 6 receptor antibody) monotherapy resulted in the improvement of renal findings and normalization of rheumatoid arthritis disease activity and serum ANCA levels. Tocilizumab can also suppress ANCA-associated vasculitis.
Collapse
Affiliation(s)
- Yusuke Yoshimura
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Shun Watanabe
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yoshifumi Ubara
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center + Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| |
Collapse
|