The effect of anti-TNF on renal function in patients with ankylosing spondylitis: a prospective cohort study

• Published in: Clinical rheumatology 2022-12, Vol.41 (12), p.3747-3752
• Main Authors: Swart, I. A. P., Visman, I. M., Heslinga, M., van der Horst-Bruinsma, I. E., van Denderen, J. C., Nurmohamed, M. T.
• Format: Article
• Language: English
• Subjects: Adalimumab - therapeutic use; Ankylosing spondylitis; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis; Body mass index; C-reactive protein; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - chemically induced; Cohort analysis; Epidermal growth factor receptors; Etanercept; Etanercept - therapeutic use; Glomerular filtration rate; Humans; Immunoglobulin G - therapeutic use; Infliximab - therapeutic use; Kidney - physiology; Medicine; Medicine & Public Health; Monoclonal antibodies; Necrosis; Original; Original Article; Prospective Studies; Receptors, Tumor Necrosis Factor - therapeutic use; Renal function; Rheumatic diseases; Rheumatic Diseases - drug therapy; Rheumatology; Risk factors; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - drug therapy; Tumor necrosis factor; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha - therapeutic use; Tumor necrosis factor-TNF
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-022-06330-9

Background Biologicals, such as anti-tumor necrosis factor (anti-TNF), reduce cardiovascular disease (CVD) in patients with inflammatory rheumatic diseases. Impaired renal function is a known predictor of CVD and elevated in ankylosing spondylitis (AS). Objective To assess the effect of anti-TNF on renal function in patients with AS and whether anti-TNF use is safe in AS patients with pre-existing risk factors for renal decline. Method Biological-naïve consecutive AS patients treated with etanercept or adalimumab were prospectively followed from 2005 to 2014. Renal function was determined by calculation of the estimated glomerular filtration rate (eGFR), estimated with the abbreviated modification of diet in renal disease (MDRD) formula. The effect of anti-TNF on eGFR was analyzed using mixed model analysis. Results 211 AS patients were followed for a median of 156 (36–286) weeks. Overall mixed model analyses showed a significant decrease of eGFR over time ( β  =  − 0.040, p  = 0.000), although this association did not remain significant after adjustment for responding to anti-TNF, alcohol use, disease duration, body mass index (BMI), C-reactive protein (CRP), and disease activity ( β  =  − 0.018, p  = 0.094). However, patients with pre-existing risk factors for renal decline did have a significant change in eGFR over time ( β  =  − 0.029, p  = 0.006). Conclusions We found a significant change in eGFR over time, although this small decrease was not clinically relevant. This study further demonstrates that anti-TNF does not affect renal function in AS patients with and without existing risk factors for renal decline, which means that use of anti-TNF is safe concerning renal function in patients with AS. Key Points • Previous studies showed that biologicals, such as anti-tumor necrosis factor (anti-TNF), reduce cardiovascular disease (CVD) in patients with inflammatory rheumatic diseases, such as ankylosing spondylitis (AS). • Impaired renal function is a known predictor of CVD, and also a known concern for many AS patients. • Use of anti-TNF is safe with regard to renal function in patients with AS. • The effect of anti-TNF on CVD in AS patients does not seem to be mediated by changes in renal function.