title: Effects of Biologic Agents in Patients with Rheumatoid Arthritis and Amyloidosis Treated with Hemodialysis.
abstract: Objective Our objective was to examine the safety and effects of therapy with biologics on the prognosis of rheumatoid arthritis (RA) patients with reactive amyloid A (AA) amyloidosis on hemodialysis (HD). Methods Twenty-eight patients with an established diagnosis of reactive AA amyloidosis participated in the study. The survival was calculated from the date of HD initiation until the time of death, or up to end of June 2015 for the patients who were still alive. HD initiation was according to the program of HD initiation for systemic amyloidosis patients associated with RA. Results Ten patients had been treated with biologics before HD initiation for a mean of 28.2 months (biologic group), while 18 had not (non-biologic group). HD was initiated in patients with similar characteristics except for the tender joint count, swollen joint count, and disease activity score (DAS)28-C-reactive protein (CRP). History of biologics showed that etanercept was frequently used for 8 patients as the first biologic. There was no significant difference in the mortality rate according to a Kaplan-Meier analysis (p=0.939) and or associated risk of death in an age-adjusted Cox proportional hazards model (p=0.758) between both groups. Infections were significantly more frequent causes of death in the biologic group than in the non-biologic group (p=0.021). However, treatment with biologics improved the DAS28-CRP score (p=0.004). Conclusion Under the limited conditions of AA amyloidosis treated with HD, the use of biologics might affect infection and thus may not improve the prognosis. Strict infection control is necessary for the use of biologics with HD to improve the prognosis.
authors.affiliation: Niigata University Health Administration Center, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kuroda
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nozawa
authors.forename: Hiroe
authors.initials: H
authors.lastname: Sato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatsue
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Wada
authors.forename: Takako
authors.initials: T
authors.lastname: Saeki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakano
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D002097:C-Reactive Protein; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods* / Q000706:statistics & numerical data; D000685:Serum Amyloid A Protein; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein