Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report
<i>Background</i>: 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 o...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/59/9/1517 |
| _version_ | 1827725443228237824 |
|---|---|
| author | Paula Kilić Lucija Ikić Miroslav Mayer Marinko Artuković Ksenija Maštrović Radončić Marina Ikić Matijašević |
| author_facet | Paula Kilić Lucija Ikić Miroslav Mayer Marinko Artuković Ksenija Maštrović Radončić Marina Ikić Matijašević |
| author_sort | Paula Kilić |
| collection | DOAJ |
| description | <i>Background</i>: 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. <i>Case Description</i>: 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. <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-10T22:29:25Z |
| format | Article |
| id | doaj.art-d3984f43334e43d9a918857f8c919737 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T22:29:25Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-d3984f43334e43d9a918857f8c9197372023-11-19T11:51:01ZengMDPI AGMedicina1010-660X1648-91442023-08-01599151710.3390/medicina59091517Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case ReportPaula Kilić0Lucija Ikić1Miroslav Mayer2Marinko Artuković3Ksenija Maštrović Radončić4Marina Ikić Matijašević5Department of Clinical Immunology, Rheumatology, and Pulmonology, University Hospital Sveti Duh, 10000 Zagreb, CroatiaDepartment of Anatomy and Physiology, University of Applied Health Sciences, 10000 Zagreb, CroatiaDepartment of Internal Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, CroatiaDepartment of Clinical Immunology, Rheumatology, and Pulmonology, University Hospital Sveti Duh, 10000 Zagreb, CroatiaDepartment of Physical Medicine and Rehabilitation, University Hospital Sveti Duh, 10000 Zagreb, CroatiaDepartment of Clinical Immunology, Rheumatology, and Pulmonology, University Hospital Sveti Duh, 10000 Zagreb, Croatia<i>Background</i>: 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. <i>Case Description</i>: 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. <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/59/9/1517rheumatoid arthritisinflammatory arthritistocilizumabinterleukin-6end-stage renal diseasehemodialysis |
| spellingShingle | Paula Kilić Lucija Ikić Miroslav Mayer Marinko Artuković Ksenija Maštrović Radončić Marina Ikić Matijašević Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report Medicina rheumatoid arthritis inflammatory arthritis tocilizumab interleukin-6 end-stage renal disease hemodialysis |
| title | Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report |
| title_full | Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report |
| title_fullStr | Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report |
| title_full_unstemmed | Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report |
| title_short | Safe and Efficient Use of Tocilizumab in Rheumatoid Arthritis Patient on Maintenance Hemodialysis: A Case Report |
| title_sort | safe and efficient use of tocilizumab in rheumatoid arthritis patient on maintenance hemodialysis a case report |
| topic | rheumatoid arthritis inflammatory arthritis tocilizumab interleukin-6 end-stage renal disease hemodialysis |
| url | https://www.mdpi.com/1648-9144/59/9/1517 |
| work_keys_str_mv | AT paulakilic safeandefficientuseoftocilizumabinrheumatoidarthritispatientonmaintenancehemodialysisacasereport AT lucijaikic safeandefficientuseoftocilizumabinrheumatoidarthritispatientonmaintenancehemodialysisacasereport AT miroslavmayer safeandefficientuseoftocilizumabinrheumatoidarthritispatientonmaintenancehemodialysisacasereport AT marinkoartukovic safeandefficientuseoftocilizumabinrheumatoidarthritispatientonmaintenancehemodialysisacasereport AT ksenijamastrovicradoncic safeandefficientuseoftocilizumabinrheumatoidarthritispatientonmaintenancehemodialysisacasereport AT marinaikicmatijasevic safeandefficientuseoftocilizumabinrheumatoidarthritispatientonmaintenancehemodialysisacasereport |