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bDMARD can prevent the progression of AA amyloidosis to end-stage renal disease
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  • Published on: 15 October 2024
    Correspondence on ‘bDMARD can prevent the progression of AA amyloidosis to end-stage renal disease’ by Kvacskay et al
    • Jiaoniu Duan, Rheumatologist Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
    • Other Contributors:
      • Jinfang Gao, Rheumatologist
      • Gailian Zhang, Rheumatologist
      • James Cheng-Chung Wei, Rheumatologist
      • Liyun Zhang, Rheumatologist

    Dear Editor,
    We read with great interest the article by Kvacskay et al. regarding the efficacy of biological disease-modifying anti-rheumatic drugs (bDMARDs) in preventing the progression of renal AA amyloidosis to end-stage renal disease (ESRD)1. The study presents valuable data on the ability of bDMARDs, particularly tocilizumab, to reduce systemic inflammation and proteinuria, offering hope for improved renal outcomes in these patients. However, several limitations not fully addressed by the authors may influence the interpretation of the findings, particularly concerning patient heterogeneity and treatment variability.
    Firstly, while the study emphasizes the reduction of inflammation through bDMARD therapy, it does not adequately address potential biases related to treatment adherence and dosing. In real-world clinical practice, patient adherence to prescribed therapies can vary significantly, and deviations from recommended dosing regimens may result in inconsistent therapeutic outcomes. For instance, patients who do not consistently follow the bDMARD administration schedule may experience higher levels of inflammation, potentially confounding the observed relationships between bDMARD use and reductions in CRP or SAA levels2, 3. A more thorough analysis that includes medication dosage, frequency of administration, timing of treatment initiation, duration of TOC therapy, and patient adherence would strengthen the study’s conclusions.
    Secondly, the het...

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    Conflict of Interest:
    None declared.