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

Abstract

Introduction: Secondary amyloidosis is a rare complication of rheumatoid arthritis (RA) that is histologically characterized by the deposition of amyloid fibrils in target organs, such as the kidneys and gastrointestinal tract. Controlling the inflammatory response is essential to prevent organ dysfunction in amyloid A (AA) amyloidosis secondary to RA, and no clear treatment strategy exists. Patient Concerns and Diagnosis: A 66-year-old woman with RA, who had been treated with disease-modifying anti-rheumatic drugs for 1 year, presented with recurrent abdominal pain and prolonged diarrhea. Endoscopy showed chronic inflammation, and colon tissue histology confirmed AA amyloidosis. Interventions and Outcomes: After tocilizumab therapy was begun, her diarrhea and abdominal pain subsided, and articular symptoms improved. Biologic drugs for RA have been used in patients with secondary AA amyloidosis, including tumor necrosis factor and Janus kinase inhibitors, interleukin 6 blockers, and a T cell modulator. Here, we systematically review existing case reports and compare the outcomes of RA-related AA amyloidosis after treatment with various drugs. Conclusion: The data indicate that biologic drugs like tocilizumab might be treatments of choice for AA amyloidosis secondary to RA.

Tratamiento con tocilizumab en amiloidosis AA: informe de casos y revisión de la literatura

“…Todos disminuyeron los reactantes de fase aguda y la proteinuria. Un informe de caso más reciente de Ju-Yang Jung y col. mostró respuesta clínica gastrointestinal y articular durante el tratamiento con tocilizumab en una paciente con artritis reumatoide complicada con amiloidosis AA 16 .…”

Interleukin 6 Inhibition in Rheumatoid Arthritis: Highlight on Olokizumab

“…112 In serial studies, IL-6 inhibitors were reported to be effective in terms of inhibiting the development and progression of renal amyloidosis, 113 including in patients with RA. 114 IL-6 inhibitors are believed to be relatively safe in patients with RA and interstitial lung diseases 115 and demyelinating diseases. 116 In addition, there are data on tocilizumab efficacy in patients with optic neuromyelitis 117 and systemic sclerosis-associated interstitial lung touchREVIEWS in RMD disease, 118,119 with the latter resulting in tocilizumab receiving approval by the US Food and Drug Administration for these patients.…”

The prospects of interleukin-6 inhibition in rheumatoid arthritis: Olokizumab (novel monoclonal antibodies to IL-6)

“…У пациентов с РА, страдающих почечной недостаточностью, на фоне лечения ингибиторами ИЛ-6 увеличения риска НЛР или ухудшения функции почек не наблюдается [105]. Отмечена определенная эффективность ингибиторов ИЛ-6 в отношении развития и прогрессирования амилоидоза почек [106], в том числе при РА [107].…”