Retention Rates of Biological Disease-Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis and Reduced...

Area of Science:

• Rheumatology
• Nephrology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) management often involves biological disease-modifying antirheumatic drugs (bDMARDs).
• Patients with RA frequently have reduced kidney function, impacting treatment choices.
• Comparative data on bDMARDs in RA patients with renal impairment is limited.

Purpose of the Study:

• To compare the drug retention rates, discontinuation hazard ratios, and effectiveness of tumor necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), and cytotoxic T lymphocyte-associated antigen-4-Ig (CTLA4-Ig) in RA patients with reduced kidney function.
• To evaluate real-world outcomes of different bDMARD classes in this specific population.

Main Methods:

• Analysis of a large-scale, real-world observational cohort study in Japan.
• Inclusion of RA patients with reduced kidney function (eGFR < 60 mL/min/1.73 m²).
• Application of inverse probability of treatment weighting (IPTW) to compare drug retention, disease activity, and physical function.

Main Results:

• Overall 3-year drug retention rate was 54.6%. Individual rates: TNFi 54.9%, IL-6i 61.1%, CTLA4-Ig 44.3%.
• Retention rates due to ineffectiveness and adverse drug reactions varied among drug classes.
• Adjusted hazard ratios for discontinuation showed no significant differences between IL-6i and CTLA4-Ig compared to TNFi. Mean disease activity and physical function scores were similar across groups at 3 years post-IPTW.

Conclusions:

• bDMARDs with different mechanisms of action demonstrate comparable drug retention and effectiveness in RA patients with reduced kidney function.
• These findings support the use of various bDMARD classes for managing RA in patients with renal impairment.