Comparative effects of biological and targeted synthetic DMARDs on incident chronic kidney disease in patients with rheumatoid arthritis
Nishimura N, Onishi A, Yamamoto W, Nagai K, Shiba H, Okita Y, Son Y, Amuro H, Okano T, Ueda Y, Hara R, Katayama M, Yamada S, Hashimoto M, Maeda Y, Onizawa H, Fujii T, Murata K, Murakami K, Tanaka M, Matsuda S, Morinobu A (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 64
Pages Range: 2395-2402
Journal Issue: 5
DOI: 10.1093/rheumatology/keae603
Abstract
Objectives: The impact of individual biological/targeted synthetic DMARD (b/tsDMARD) on kidney function in patients with RA remains unclear. This study aimed to determine the comparative effects of b/tsDMARDs on chronic kidney disease (CKD) incidence in patients with RA. Methods: This multicentre cohort study included patients with RA who had baseline estimated glomerular filtration rate (eGFR) of ≥60 ml/min/1.73 m2 and started a TNF inhibitor (TNFi), cytotoxic T-lymphocyte-associated antigen-4-Ig (CTLA4-Ig), interleukin-6 receptor inhibitor, or Janus kinase inhibitor (JAKi) in Japan. Multiple propensity score-based inverse probability weighting (IPW) was used to adjust confounders. The incidence of CKD was compared among b/tsDMARDs using IPW mixed-effect Cox proportional hazards models and linear mixed-effect models with IPW-examined trajectories of eGFR. Results: Among 2187 patients with 3068 treatment courses and up to 11 years of follow-up, CKD occurred in 275 cases. Compared with the CTLA4-Ig group, the TNFi group had a significantly lower CKD incidence [hazard ratio (HR) 0.67, 95% CI 0.46-0.97, P = 0.04], whereas the JAKi group had a significantly higher incidence (HR 2.16, 95% CI 1.23-3.79, P = 0.01). The trajectory of eGFR was significantly greater in the JAKi group than in the CTLA4-Ig group (CTLA4-Ig: -1.28 ml/min/1.73 m2/year, JAKi: -2.29 ml/min/1.73 m2/year, P < 0.001). Conclusions: TNFi use was associated with reduced CKD incidence, whereas JAKi showed a less protective association for kidney function in patients with RA.
Involved external institutions
Nara Medical University
Japan (JP)
Osaka Red Cross Hospital
Japan (JP)
Osaka Metropolitan University (OMU)
Japan (JP)
Shiga General Hospital / 滋賀県立総合病院
Japan (JP)
Kurashiki Sweet Hospital
Japan (JP)
Osaka Medical and Pharmaceutical University
Japan (JP)
Kansai Medical University
Japan (JP)
Kobe University Hospital / 神戸大学医学部附属病院
Japan (JP)
Japan (JP)
Osaka Red Cross Hospital
Japan (JP)
Osaka Metropolitan University (OMU)
Japan (JP)
Shiga General Hospital / 滋賀県立総合病院
Japan (JP)
Kurashiki Sweet Hospital
Japan (JP)
Osaka Medical and Pharmaceutical University
Japan (JP)
Kansai Medical University
Japan (JP)
Kobe University Hospital / 神戸大学医学部附属病院
Japan (JP)
How to cite
APA:
Nishimura, N., Onishi, A., Yamamoto, W., Nagai, K., Shiba, H., Okita, Y.,... Morinobu, A. (2025). Comparative effects of biological and targeted synthetic DMARDs on incident chronic kidney disease in patients with rheumatoid arthritis. Rheumatology, 64(5), 2395-2402. https://doi.org/10.1093/rheumatology/keae603
MLA:
Nishimura, Nozomi, et al. "Comparative effects of biological and targeted synthetic DMARDs on incident chronic kidney disease in patients with rheumatoid arthritis." Rheumatology 64.5 (2025): 2395-2402.
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