Objectives The impact of individual biological/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) on kidney function in patients with rheumatoid arthritis (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 tumor necrosis factor inhibitor (TNFi), cytotoxic T lymphocyte-associated antigen-4-Ig (CTLA4-Ig), interleukin-6 receptor inhibitor (IL-6Ri), 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% confidence interval [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.

中文翻译：

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生物和靶向合成 DMARD 对类风湿性关节炎患者慢性肾病发病率的比较影响


目的 个体生物/靶向合成疾病缓解抗风湿药 （b/tsDMARD） 对类风湿性关节炎 （RA） 患者肾功能的影响仍不清楚。本研究旨在确定 b/tsDMARDs 对 RA 患者慢性肾脏病 （CKD） 发病率的比较影响。方法 这项多中心队列研究纳入了基线估计肾小球滤过率 （eGFR） 为 ≥ 60 mL/min/1.73 m2 并开始使用肿瘤坏死因子抑制剂 （TNFi） 、细胞毒性 T 淋巴细胞相关抗原-4-Ig （CTLA4-Ig）、白细胞介素-6 受体抑制剂 （IL-6Ri） 或 Janus 激酶抑制剂 （JAKi） 的 RA 患者在日本。使用基于多倾向得分的逆概率加权 （IPW） 来调整混杂因素。使用 IPW 混合效应 Cox 比例风险模型和线性混合效应模型比较 b/tsDMARD 的 CKD 发生率，其中 IPW 检查 eGFR 的轨迹。结果 2187 例患者，3068 个疗程，随访长达 11 年，其中 275 例发生 CKD。与 CTLA4-Ig 组相比，TNFi 组的 CKD 发生率显著降低 （风险比 [HR] 0.67,95% 置信区间 [CI] 0.46-0.97，p = 0.04），而 JAKi 组的发生率显著较高 （HR 2.16,95% CI 1.23-3.79，p = 0.01）。JAKi 组的 eGFR 轨迹显著大于 CTLA4-Ig 组 （CTLA4-Ig： -1.28 mL/min/1.73 m2/年，JAKi：-2.29 mL/min/1.73 m2/年，p< 0.001）。结论 TNFi 使用与 CKD 发生率降低相关，而 JAKi 对 RA 患者肾功能的保护性关联较小。