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Biomolecules 2018, 8(4), 136; https://doi.org/10.3390/biom8040136

Rituximab Therapy in Renal Amyloidosis Secondary to Rheumatoid Arthritis

1
Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
2
Department of Internal Medicine, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
*
Author to whom correspondence should be addressed.
Received: 9 September 2018 / Revised: 17 October 2018 / Accepted: 24 October 2018 / Published: 5 November 2018
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Abstract

Secondary amyloid A (AA) amyloidosis is a late and serious complication of poorly controlled, chronic inflammatory diseases. Rheumatoid arthritis (RA) patients with poorly controlled, longstanding disease and those with extra-articular manifestations are under risk for the development of AA amyloidosis. Although new drugs have proven to be significantly effective in the treatment of secondary AA amyloidosis, no treatment modality has proven to be ideal. To date, only in small case series preliminary clinical improvement have been shown with rituximab therapy for AA amyloidosis secondary to RA that is refractory to TNF-α inhibitors (TNF-i) therapy. In these case series, we assessed the efficacy and safety of rituximab therapy for patients with RA and secondary amyloidosis. Hacettepe University Biologic Registry was developed at 2005. The data of the RA patients who were prescribed a biological drug were recorded regularly. Patients with biopsy proven AA amyloidosis patients were screened. Of 1022 RA patients under biologic therapy, 0.7% patients had clinically apparent histologically confirmed amyloidosis. Four of seven patients who were prescribed rituximab at least one infusion enrolled to those case series. Two of four patients showed significant clinical improvement and one of them also had decrease in proteinuria and the other one had stable renal function and proteinuria. The main goal for the treatment of AA amyloidosis is to control the activity of the underlying disorder. In this study, we showed that rituximab may be an effective treatment in RA patients with amyloidosis who were unresponsive to conventional disease modifying anti-rheumatic drugs (DMARDs) and/or TNFi. View Full-Text
Keywords: rituximab; amyloidosis; rheumatoid arthritis; biologic registry; proteinuria rituximab; amyloidosis; rheumatoid arthritis; biologic registry; proteinuria
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Kilic, L.; Erden, A.; Sener, Y.Z.; Armagan, B.; Sari, A.; Kalyoncu, U.; Karadag, O.; Akdogan, A.; Dogan, I.; Apras Bilgen, S.; Kiraz, S.; Ertenli, I. Rituximab Therapy in Renal Amyloidosis Secondary to Rheumatoid Arthritis. Biomolecules 2018, 8, 136.

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