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Abstract：
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.
METHODS: 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.
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.
METHODS: 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.
摘要：
背景：生物制品，如抗肿瘤坏死因子（anti-TNF），减少炎症性风湿性疾病患者的心血管疾病（CVD）。肾功能受损是心血管疾病的已知预测因子，并且在强直性脊柱炎（AS）中升高。
目的：评估抗TNF对AS患者肾功能的影响，以及在存在肾功能下降危险因素的AS患者中使用抗TNF是否安全。
方法：从2005年至2014年，前瞻性随访接受依那西普或阿达木单抗治疗的生物学初治AS患者。通过计算估计的肾小球滤过率（eGFR）来确定肾功能，用肾脏疾病饮食的缩写修改(MDRD)公式估计。使用混合模型分析来分析抗TNF对eGFR的影响。
结果：211例AS患者的中位随访时间为156（36-286）周。总体混合模型分析显示，随着时间的推移，eGFR显著下降(β=-0.040，p=0.000)，尽管在校正抗TNF应答后，这种关联并不显著，酒精使用,疾病持续时间,体重指数（BMI），C反应蛋白(CRP),和疾病活动性（β=-0.018，p=0.094）。然而,预先存在肾功能下降危险因素的患者的eGFR随时间变化显著(β=-0.029,p=0.006).
结论：我们发现eGFR随时间发生显著变化，尽管这一小幅下降与临床无关。这项研究进一步表明，在有或没有肾脏下降的危险因素的AS患者中，抗TNF不影响肾功能。这意味着使用抗TNF对AS患者的肾功能是安全的。关键点•以前的研究表明，生物制品，如抗肿瘤坏死因子（anti-TNF），减少炎症性风湿性疾病患者的心血管疾病（CVD），如强直性脊柱炎（AS）。•肾功能受损是CVD的已知预测因子，也是许多AS患者已知的担忧。•使用抗TNF对AS患者的肾功能是安全的。•在AS患者中，抗TNF对CVD的影响似乎不是由肾功能的变化介导的。
目的：评估抗TNF对AS患者肾功能的影响，以及在存在肾功能下降危险因素的AS患者中使用抗TNF是否安全。
方法：从2005年至2014年，前瞻性随访接受依那西普或阿达木单抗治疗的生物学初治AS患者。通过计算估计的肾小球滤过率（eGFR）来确定肾功能，用肾脏疾病饮食的缩写修改(MDRD)公式估计。使用混合模型分析来分析抗TNF对eGFR的影响。
结果：211例AS患者的中位随访时间为156（36-286）周。总体混合模型分析显示，随着时间的推移，eGFR显著下降(β=-0.040，p=0.000)，尽管在校正抗TNF应答后，这种关联并不显著，酒精使用,疾病持续时间,体重指数（BMI），C反应蛋白(CRP),和疾病活动性（β=-0.018，p=0.094）。然而,预先存在肾功能下降危险因素的患者的eGFR随时间变化显著(β=-0.029,p=0.006).
结论：我们发现eGFR随时间发生显著变化，尽管这一小幅下降与临床无关。这项研究进一步表明，在有或没有肾脏下降的危险因素的AS患者中，抗TNF不影响肾功能。这意味着使用抗TNF对AS患者的肾功能是安全的。关键点•以前的研究表明，生物制品，如抗肿瘤坏死因子（anti-TNF），减少炎症性风湿性疾病患者的心血管疾病（CVD），如强直性脊柱炎（AS）。•肾功能受损是CVD的已知预测因子，也是许多AS患者已知的担忧。•使用抗TNF对AS患者的肾功能是安全的。•在AS患者中，抗TNF对CVD的影响似乎不是由肾功能的变化介导的。
