Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report

Scientific paper - Case study

• Author: Paula Kilić
• Author: Lucija Ikić
• Author: Miroslav Mayer
• Author: Marinko Artuković
• Author: Ksenija Maštrović Radončić
• Author: Marina Ikić Matijašević
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (english)

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune and inflammatory disease. Conventional synthetic and biologic disease-modifying antirheumatic drugs (DMARDs), Janus kinase inhibitors, and rituximab are used to treat the disease. There are no recommendations or guidelines for the treatment of patients with both inflammatory arthritis and end-stage renal disease (ESRD), despite the safety and efficacy of the mentioned drugs. The anti-interleukin-6 receptor antibody tocilizumab (TCZ) has not been used as a long-term therapy for hemodialysis (HD) patients with RA, except in a few case reports. Case
Description: We present the case of a 41-year-old patient with RA and ESRD on maintenance HD due to type 1 diabetes-related complications. Due to high RA disease activity, the patient was not a suitable candidate for a kidney transplant. Because TCZ is used to treat both RA and kidney transplant rejection, therapy with a full dose of TCZ was administered. The patient has achieved sustained clinical remission (for the past four years) with no adverse events reported.
Conclusions: Herein, we present the safe and effective use of TCZ in an RA patient on HD who is also a candidate for kidney transplant. Consequently, TCZ could be the treatment of choice for RA patients with ESRD who have not achieved disease control (low activity or remission) with conventional synthetic DMARDs. Clinical studies are required to evaluate the efficacy and safety of biologic DMARDs and Janus kinase inhibitors in patients with both inflammatory arthritis and ESRD.

• Keywords (english): Adult; Antirheumatic Agents / therapeutic use; Arthritis, Rheumatoid / complications; Arthritis, Rheumatoid / drug therapy; Biological Products; Humans; Janus Kinase Inhibitors; Kidney Failure, Chronic / complications; Kidney Failure, Chronic / therapy; Renal Dialysis
• Language: english
• Publication type: Scientific paper - Case study
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Medicina
• Numbering: vol. 59, no. 9, 1517
• e-ISSN: 1648-9144
• DOI: https://doi.org/10.3390/medicina59091517
• URN:NBN: urn:nbn:hr:105:091889
• Publication: 2023-08-23
• Document URL: https://www.mdpi.com/1648-9144/59/9/1517
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-05-21 07:56:36