Tocilizumab Attenuates Anti-neutrophil Cytoplasmic Antibody-associated Nephritis Occurring during Abatacept and Adalimumab Therapy for Rheumatoid Arthritis

We encountered an 86-year-old Japanese woman who presented with proteinuria (0.4 g/day) and hematuria (red blood cell sediment >100/high-power field), a decreased renal function (serum creatinine, 1.51 mg/dL), and elevated myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (23...

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Bibliographic Details
Published in:Internal Medicine 2023/07/15, Vol.62(14), pp.2099-2102
Main Authors: Yoshimura, Yusuke, Watanabe, Shun, Yamanouchi, Masayuki, Ikuma, Daisuke, Mizuno, Hiroki, Sekine, Akinari, Hasegawa, Eiko, Suwabe, Tatsuya, Kono, Kei, Kinowaki, Keiichi, Ohashi, Kenichi, Ubara, Yoshifumi, Sawa, Naoki
Format: Article
Language:English
Subjects:
Abatacept - adverse effects
Adalimumab - adverse effects
Aged, 80 and over
ANCA-associated glomerulonephritis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - chemically induced
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy
Antibodies, Antineutrophil Cytoplasmic
Antineutrophil cytoplasmic antibodies
Arthritis, Rheumatoid - drug therapy
Biopsy
Case Report
Creatinine
Cytotoxicity
Erythrocytes
Female
Glomerulonephritis
Glomerulonephritis - chemically induced
Glomerulonephritis - drug therapy
Hematuria
Humans
Interleukin 6
Internal medicine
Leukocytes (neutrophilic)
Lymphocytes T
Monoclonal antibodies
Nephritis
Peroxidase
Proteinuria
Renal function
Rheumatoid arthritis
TNF-α inhibitor
tocilizumab
Vasculitis
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Summary:We encountered an 86-year-old Japanese woman who presented with proteinuria (0.4 g/day) and hematuria (red blood cell sediment >100/high-power field), a decreased renal function (serum creatinine, 1.51 mg/dL), and elevated myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (231 IU/mL) during treatment of rheumatoid arthritis with abatacept (a cytotoxic T-lymphocyte-associated antigen 4 agent) and adalimumab (a tumor necrosis factor-α agent). A kidney biopsy showed pauci-immune necrotizing glomerulonephritis, and ANCA-associated vasculitis was diagnosed. Treatment with tocilizumab (an interleukin 6 receptor antibody) monotherapy resulted in the improvement of renal findings and normalization of rheumatoid arthritis disease activity and serum ANCA levels. Tocilizumab can also suppress ANCA-associated vasculitis.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.0858-22