Article Text

PDF
AB0341 Experience of tocilizumab usage in chronic renal insufficiency stipulated by aa-amyloidosis due to rheumatoid arthritis complication
  1. A. Alexeeva1,
  2. Y. Mouraviev1,
  3. E. Nasonov1
  1. 1FEDERAL STATE BUDGETARY INSTITUTION “RESEARCH INSTITUTE OF RHEUMATOLOGY” UNDER THE RUSSIAN ACADEMY OF MEDICAL SCIENCES, Moscow, Russian Federation

Abstract

Background Uremia stipulated by AA-amyloidosis is one of basic lethal causes in rheumatoid arthritis (RA) pts in Russia.

Methods RA pts resistant to earlier therapy with chronic renal insufficiency, stipulated by morphologically confirmed AA-amyloidosis. Tocilizumab in dosage of 8mg/kg of body weight was administrated iv every 4 weeks for the period of observation, with regular control of integral index DAS28, creatinin clearance (ml/min), amyloid A (mg/l), proteinuria (g/24Hr).

Results The study included 5 RA pts – women with medial age of 56.6±1.8 years, medial arthritis duration 18.8±5.5 with morphologically confirmed AA-amyloidosis (bioptates: kidneys -1 pt, duodenal mucous – 4 pts), with moderate renal function insufficiency: creatinin clearance (CrCl) – 36.0±3.7 ml/min, active inflammatory process – averagely DAS28was equal to 5.8±0.8, median amyloid A 61.3±19.2. Disease modifying anti-rheumatic drugs (DMARD) applied earlier to all pts – Metotrexate, Leflunomide and three of them –FNO-a - Infliximab, Humira, were withdrawn due to inefficacy or unfavorable reactions. Average period of Tocilizumab therapy was 7 months (10 months – 1, 7 months – 3, 4 months – 1 pt). At the end of observation the following indices were seen: CrCl increase to 49.2±6.7, SAA decrease 18.8±10.2 and DAS28 index – 3.2±0.8 (p<0.005). Proteinuria was considerably diminished in 2 and disappeared in 1 pts. There were no adverse effects, requiring withdrawal of Tocilizumab.

Conclusions Our experience allows us to discuss the expedience of Tocilizumab usage in chronic renal insufficiency, stipulated by AA-amyloidosis, complicating RA and resistant to traditional DMARD and FNO-a inhibitors.

Disclosure of Interest None Declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.