Adalimumab Safe for Patients with RA and Renal Insufficiency

VBCR - April 2013, Volume 2, No 2 - In the Literature

A common comorbidity in patients with RA, renal insufficiency is caused by agents such as nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and methotrexate. Some of these drugs may even have toxic side effects when used in patients with only mild renal insufficiency.  Methotrexate, an anchor drug for the treatment of RA, can cause severe con­­sequences at very low doses (ie, 2.5 mg once weekly), and in some cases, can even be fatal.

A recent study showed that adalimumab did not worsen renal function or have other serious adverse events in patients with RA and renal insufficiency, including patients with end-stage renal disease who were undergoing hemodialysis (Sumida K, et al. Arthritis Care Res [Hoboken]. 2013;65: 471-475).

In the study, 65 patients with RA (in­cluding 2 patients who were undergoing hemodialysis) were treated with adalimumab 40 mg subcutaneously every other week in the Nephrology Center of Toranomon Hospital in Toyko, Japan, from December 2008 to June 2011.

The 2 patients who were undergoing hemodialysis received adalimumab on nonhemodialysis days. The patients’ renal function was evaluated using the estimated glomerular filtration rate (eGFR). Changes in eGFR were compared between patients with renal insufficiency (N = 39) and patients without renal insufficiency (N = 26). Renal insufficiency was defined as an eGFR of <60 mL/minute/1.73 m2.

No significant differences were found between the 2 groups in the proportion of patients who discontinued or who changed adalimumab treatment (51.3% vs 50%; P = .53). The mean changes in eGFR between the patients with renal insufficiency and the patients without renal insufficiency were not significant (P = .92 and P = .78, respectively).

These results indicate that adalimumab does not adversely affect renal function or cause serious adverse events in patients with RA who have renal insufficiency, including patients who are undergoing hemodialysi.

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