Impact of biologic and targeted synthetic DMARDs on disease activity and renal function in rheumatic patients with chronic kidney disease

Chronic kidney disease (CKD) is a common comorbidity in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (AxSpA), complicating treatment strategies. Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are effective in managing these rheumatic diseases; however, their renal safety in patients with CKD remains incompletely characterized. This study aimed to evaluate the effects of b/tsDMARDs on disease activity and renal function in patients with RA, PsA, and AxSpA with concomitant CKD. A retrospective analysis was conducted in 51 patients with CKD treated with b/tsDMARDs, including anti-TNF agents, non-TNF biologics, and targeted synthetic DMARDs (tofacitinib). Disease activity parameters and estimated glomerular filtration rate (e-GFR) were assessed at baseline and at the final visit. Changes in CKD stage were classified as improved, worsened, or stable. Significant improvements in disease activity were observed, including reductions in ESR (p < 0.001), CRP (p < 0.001), DAS28–CRP (p < 0.001), and BASDAI (p < 0.001). No significant change in e-GFR was observed between baseline and the final visit (p = 0.911), and the annual change in e-GFR remained stable across treatment groups, sex, and disease classifications. CKD stage improved or remained stable in 74.5% of patients. Although non-etanercept anti-TNF agents were associated with a more favorable annual change in e-GFR compared with etanercept (p = 0.026), this finding should be interpreted cautiously given baseline differences between treatment groups. In patients with RA, PsA, and AxSpA with CKD, b/tsDMARDs were associated with significant improvement in disease activity without evidence of deterioration in renal function. These findings support the overall renal safety of b/tsDMARDs in this population. However, due to the retrospective design and lack of a control group, no definitive conclusions regarding renal benefit can be drawn.