title: Etanercept treatment in rheumatoid arthritis patients with chronic kidney failure on predialysis.
abstract: Rheumatoid arthritis (RA) patients with chronic kidney failure are intolerant to most disease-modifying antirheumatic drugs (DMARDs) and NSAIDs due to their potential toxicities. Although the tumor necrosis factor (TNF) inhibitors have emerged as a highly effective treatment for RA, their safety and efficacy in RA patients with chronic kidney failure have not been well reported. We retrospectively evaluated the safety and efficacy of etanercept treatment in RA patients with chronic kidney failure. We describe three RA patients with chronic kidney failure who had been treated with DMARDs, steroids and NSAIDs, but were discontinued from these classical agents due to several side effects and nephrotoxicity. The patients were treated with 25 mg of etanercept once or twice a week. We evaluated disease activity and used decreasing renal function and increasing number of infections to monitor safety. All three patients improved after starting etanercept treatment and their steroid requirements were decreased. Linear relationships between Modification of Diet in Renal Disease study equation (MDRD) glomerular filtration rate (GFR) and time were observed. Thus, in all patients, the changes in GFR did not represent superimposed acute drug toxicity, but rather chronic progressive renal failure. These cases show that etanercept may be a safe and effective treatment option for RA patients with chronic kidney failure.
authors.affiliation: Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University Medical Center, Seoul, 133-792, Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Cho
authors.forename: Yoon-Kyoung
authors.initials: YK
authors.lastname: Sung
authors.forename: Songree
authors.initials: S
authors.lastname: Park
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Bae
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept
references.citation: Lancet. 1999 Jan 23;353(9149):259-66
references.pmid: 9929017
references.citation: J Rheumatol. 1999 May;26(5):1176-86
references.pmid: 10332987
references.citation: Semin Arthritis Rheum. 2000 Dec;30(3):196-208
references.pmid: 11124283
references.citation: Clin Exp Rheumatol. 2007 Jul-Aug;25(4):518-22
references.pmid: 17888205
references.citation: Nephrol Dial Transplant. 2004 Aug;19 Suppl 5:V73-78
references.pmid: 15284364
references.citation: Mod Rheumatol. 2008;18(3):293-5
references.pmid: 18299957
references.citation: Rheumatology (Oxford). 2006 Mar;45(3):357-9
references.pmid: 16368727
references.citation: Arch Intern Med. 1999 Nov 22;159(21):2542-50
references.pmid: 10573044
references.citation: J Rheumatol. 1995 Jan;22(1):38-40
references.pmid: 7699678
references.citation: Clin Nephrol. 1986 May;25(5):268-71
references.pmid: 3720037
references.citation: Arthritis Rheum. 2003 Jul;48(7):2019-24
references.pmid: 12847696
references.citation: J Rheumatol. 2002 Mar;29(3):636-7
references.pmid: 11908584
references.citation: J Clin Pharmacol. 1994 Aug;34(8):859-64
references.pmid: 7525661
references.citation: J Pharm Pharmacol. 2005 Nov;57(11):1407-13
references.pmid: 16259772