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.

Infliximab as Alternative Therapy in Renal AA Amyloidosis Secondary to Rheumatoid Arthritis

“…In this study, including 53 RA with AA amyloidosis treated by biotherapy mainly anti-TNF alpha in first intention, there was a decrease in mortality in these patients compared to patients who were not under biotherapy but without reduction of the risk of the evolution towards hemodialysis. In another retrospective German multicenter study [13], 30 cases of amyloidosis secondary to RA treated with biologic agents were reported (23 were treated by anti-TNF TNF-blocking agents). Proteinuria values decreased by 25% in 13 of 23 patients and remained stable in 5 patients.…”

Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy

“…In a report of biologic therapy use for secondary renal AA amyloidosis in RA and ankylosing spondylitis, 29 patients with RA and proteinuria and one patient with RA and end-stage renal disease (ESRD) were treated with biologic agents (TNF inhibitors in 23 patients, rituximab in 10, abatacept in 5, tocilizumab in 4, and anakinra in 1). [ 48 ] Proteinuria regressed by 25% in 13 patients and creatinine decreased by 25% in 2/23 patients; however, seven patients developed ESRD after biologic therapy. When the response of secondary amyloidosis to biologic therapy was evaluated using a composite response index based on disease activity, proteinuria, and renal functions, 52.2% (12/23) of patients with RA had good responses.…”

Amyloidoza AA — przyczyny, diagnostyka, opcje terapeutyczne

“…W takcie badania zaobserwowano 10 epizodów ciężkich zakażeń związanych ze stosowanym leczeniem, 4 epizody anafilaksji i 4 przypadki zakrzepicy [47]. Wydaje się, że hamowanie aktywności anty-TNF jest skuteczniejsze, jeśli choroba podstawową jest RZS lub zesztywniające zapalenie stawów kręgosłupa [48]. To skuteczniejsza terapia niż stosowany w przeszłości cyklofosfamid [49].…”