Use of Biologic Therapy in AA Amyloidosis Patients Undergoing Dialysis-A Systematic Literature Review.

Ege Sinan Torun, Gülay Kadıoğlu
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Abstract

Background: The advent of biological agents has provided significant therapeutic opportunities for patients with AA amyloidosis. However, when these patients reach end-stage renal disease and begin dialysis, some clinicians may discontinue biological treatments due to the heightened risk of infections. Given that AA amyloidosis is a progressive condition, there is a potential for the disease to affect additional organs in these patients. Consequently, we aimed to evaluate the benefits and risks associated with biological agents in AA amyloidosis patients receiving dialysis.

Method: We performed a systematic literature review in Cochrane Database and MEDLINE about the use of biologic agents in AA amyloidosis patients undergoing dialysis.

Results: We identified fifty-five patients across twenty-two studies. Familial Mediterranean fever was the etiology in 21 patients (71.4% anakinra and 28.6% canakinumab), rheumatoid arthritis in 17 patients (52.9% etanercept and 47.1% tocilizumab), unknown etiology in 8 patients (62.5% anakinra and 37.5% tocilizumab), ankylosing spondylitis in 5 patients (40% etanercept, 40% adalimumab, and 20% infliximab), hidradenitis suppurativa in 3 patients and tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in 1 patient. Biologic agents were effective or partially effective for primary disease control in 52 patients (94.5%). Two patients were able to discontinue dialysis. Most frequent side effects were infections (8 episodes in 7 patients). Eight patients died (5 due to infections, one due to cardiac causes and two due to pulmonary hemorrhage).

Conclusion: Biologic agents are effective in AA amyloidosis patients that are treated with dialysis and seem to have an acceptable safety profile.

在接受透析的 AA 淀粉样变性患者中使用生物疗法--系统性文献综述。
背景:生物制剂的出现为 AA 淀粉样变性患者提供了重要的治疗机会。然而,当这些患者进入肾病晚期并开始透析时,一些临床医生可能会因感染风险增加而停止生物治疗。鉴于 AA 淀粉样变性是一种进展性疾病,该病有可能影响这些患者的其他器官。因此,我们旨在评估生物制剂对接受透析的 AA 淀粉样变性患者的益处和风险:我们在 Cochrane 数据库和 MEDLINE 中对接受透析的 AA 淀粉样变性患者使用生物制剂的情况进行了系统性文献回顾:结果:我们在22项研究中发现了55名患者。21例患者的病因是家族性地中海热(71.4%为阿纳金拉,28.6%为卡那珠单抗),17例患者的病因是类风湿性关节炎(52.9%为依那西普,47.1%为托西珠单抗),8例患者的病因不明(62.5%为阿纳金拉,37.5名患者为强直性脊柱炎(依那西普占40%、阿达木单抗占40%、英夫利昔单抗占20%),3名患者为化脓性扁桃体炎,1名患者为肿瘤坏死因子受体相关周期性综合征(TRAPS)。生物制剂对 52 名患者(94.5%)的原发性疾病控制有效或部分有效。两名患者能够停止透析。最常见的副作用是感染(7 名患者出现 8 次)。8名患者死亡(5人死于感染,1人死于心脏病,2人死于肺出血):结论:生物制剂对接受透析治疗的 AA 淀粉样变性患者有效,而且似乎具有可接受的安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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