title: A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients.
abstract: In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy-based on creatinine level, proteinuria and disease activity-was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.
authors.affiliation: Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey. onpamuk@gmail.com.
authors.forename: Ömer Nuri
authors.initials: ÖN
authors.lastname: Pamuk
authors.affiliation: Division of Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Kalyoncu
authors.affiliation: Division of Rheumatology, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Aksu
authors.affiliation: Division of Rheumatology, Ankara Numune Research and Education Hospital, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Omma
authors.affiliation: Division of Rheumatology, Uludag University Medical Faculty, Bursa, Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Pehlivan
authors.affiliation: Division of Rheumatology, Medipol University, Istanbul, Turkey.
authors.forename: Yonca
authors.initials: Y
authors.lastname: Çağatay
authors.affiliation: Division of Rheumatology, Ankara Numune Research and Education Hospital, Ankara, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Küçükşahin
authors.affiliation: Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey.
authors.forename: Salim
authors.initials: S
authors.lastname: Dönmez
authors.affiliation: Division of Rheumatology, Sütçü İmam University Medical Faculty, Kahramanmaraş, Turkey.
authors.forename: Gözde Yıldırım
authors.initials: GY
authors.lastname: Çetin
authors.affiliation: Hatay State Hospital, Hatay, Turkey.
authors.forename: Rıdvan
authors.initials: R
authors.lastname: Mercan
authors.affiliation: Division of Rheumatology, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Özün
authors.initials: Ö
authors.lastname: Bayındır
authors.affiliation: Division of Rheumatology, Kocaeli University Medical Faculty, Kocaeli, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Çefle
authors.affiliation: Van Research and Education Hospital, Van, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yıldız
authors.affiliation: Division of Rheumatology, Pamukkale University Medical Faculty, Denizli, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Balkarlı
authors.affiliation: Division of Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Kılıç
authors.affiliation: Division of Rheumatology, Fatih Sultan Mehmet Research and Education Hospital, Istanbul, Turkey.
authors.forename: Necati
authors.initials: N
authors.lastname: Çakır
authors.affiliation: Division of Rheumatology, Gaziantep University Medical Faculty, Gaziantep, Turkey.
authors.forename: Bünyamin
authors.initials: B
authors.lastname: Kısacık
authors.affiliation: Division of Rheumatology, Uludag University Medical Faculty, Bursa, Turkey.
authors.forename: Mustafa Ferhat
authors.initials: MF
authors.lastname: Öksüz
authors.affiliation: Division of Rheumatology, Pamukkale University Medical Faculty, Denizli, Turkey.
authors.forename: Veli
authors.initials: V
authors.lastname: Çobankara
authors.affiliation: Division of Rheumatology, Gaziantep University Medical Faculty, Gaziantep, Turkey.
authors.forename: Ahmet Mesut
authors.initials: AM
authors.lastname: Onat
authors.affiliation: Division of Rheumatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sayarlıoğlu
authors.affiliation: Division of Rheumatology, Gazi University Medical Faculty, Ankara, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Öztürk
authors.affiliation: Division of Hematology, Trakya University Medical Faculty, Edirne, Turkey.
authors.forename: Gülsüm Emel
authors.initials: GE
authors.lastname: Pamuk
authors.affiliation: Division of Rheumatology, Dokuz Eylül University Medical Faculty, Edirne, Turkey.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Akkoç
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology; D015995:Prevalence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D014421:Turkey / Q000453:epidemiology
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; Anti-TNF; Biologic therapy; Rheumatoid arthritis; Secondary amyloidosis