Background Reactive amyloid A (AA) amyloidosis is a serious and life-threatening systemic complication of rheumatoid arthritis (RA).Recently, therapy with biologic agents such as anti- tumor necrosis factor (TNF) and anti- interleukin (IL)-6 antibodies has developed against a background of increased understanding of the pathogenesis of rheumatoid arthritis (RA), representing a tremendous advance in the management of RA. However, the prognosis of amyloid patients treated with biologics has not yet been clearly investigated.
Objectives Our purpose was to examine the safety of therapy with anti-tumor necrosis factor and anti-interleukin-6 biologic agents in RA patients with reactive AA amyloidosis, together with prognosis and hemodialysis (HD)-free survival, in comparison with AA amyloidosis patients without such therapy.
Methods One hundred thirty-three patients with an established diagnosis of reactive AA amyloidosis participated in the study. Clinical data were assessed from the patient records at the time of amyloid detection and administration of biologics. Survival was calculated from the date when amyloid was first demonstrated histologically until the time of death, or up to end of 2010, for the patients who were still alive. Patients who had been started on HD were selected for inclusion only after the presence of amyloid had been demonstrated. Assessment of the association of various factors with survival was performed on the date of the original diagnosis.
Results Fifty-three patients were treated with biologic agents (biologic group) and 80 were not (non-biologic group). Survival rate was significantly higher in the biologic group than in the non-biologic group (p=0.001). Nine patients in the biologics group and 33 in the non-biologic group were started on HD. HD-free survival was significantly higher in the biologic group (p=0.00004).
Conclusions Patients with amyloidosis have a higher mortality rate, but that the use of biologic agents reduces mortality among them. Additionally, the use of biologics improves the HD-free survival rate.
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Disclosure of Interest None Declared