Efficacy and safety of first-line targeted synthetic DMARDs in rheumatoid arthritis patients with chronic kidney disease.

OBJECTIVES

To evaluate the efficacy and safety of first-line targeted synthetic DMARDs (tsDMARDs) in patients with RA and chronic kidney disease (CKD).

METHODS

This retrospective cohort study included 216 patients with RA prescribed their first tsDMARDs at two hospitals between 2013 and 2022. Dose reduction and contraindication guidelines for tsDMARDs according to kidney function were followed. The patients were categorized by kidney function and tsDMARD modality. The primary outcome was the 24-month drug retention rate, and the secondary outcomes were changes in the Disease Activity Score 28-CRP (DAS28-CRP) level, prednisolone dosage and reasons for discontinuation.

RESULTS

The 24-month drug retention rates according to the estimated glomerular filtration rate (eGFR) (≥60%, 30-60% or <30 ml/min/1.73 m2) were as follows: 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 was 1.14 [95% confidence interval, 0.81-1.62], P = 0.45). Patients had a decreased DAS28-CRP (P < 0.01) and a reduced prednisolone dosage (P < 0.01) over the six-month period following tsDMARD initiation. The incidence of herpes zoster and deep vein thrombosis (DVT) was higher in the group with an eGFR <30 ml/min/1.73 m2, but not statistically significant.

CONCLUSIONS

tsDMARDs have demonstrated efficacy and safety in patients with RA and CKD; however, clinicians should consider the potential for herpes zoster and DVT in patients with eGFR <30 ml/min/1.73 m2.