Yildirim Tolga, Yilmaz Rahmi, Saglam Arzu, Uzerk-Kibar Muge, Jabrayilov Jabrayil, Erdem Yunus
Hacettepe University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey.
Hacettepe University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey.
Nefrologia (Engl Ed). 2021 Mar 16. doi: 10.1016/j.nefro.2020.11.011.
Canakinumab, an IL-1 blocking drug, decreases the frequency and severity of the attacks and decreases the proteinuria level in colchicine resistant/intolerant familial Mediterranean fever (FMF) patients. However, it is not known whether patients with impaired or preserved renal functions respond differently to IL-1 blocking therapies in terms of proteinuria reduction and progression of kidney dysfunction which was the aim of this study.
Adult FMF subjects with biopsy proven amyloidosis who had 24-h urine protein excretion>150mg/day before initiation of canakinumab were divided into two groups as patients with preserved renal function (GFR≥60mL/min) and patients with impaired renal function (GFR<60mL/min). The response in proteinuria and renal functions are compared between two groups in this cross-sectional study.
A total of 18 patients (11 with preserved and 7 with impaired renal function) were included in this study. Although proteinuria levels of both groups were similar at the baseline and at six months after initiation of canakinumab, proteinuria at 12 months was significantly lower for patients with preserved renal function compared to patients with impaired renal function (2462±1760mg/day vs. 7065±3035mg/day respectively, p=0.02). All of the patients with preserved renal function had more than 50% decrease in proteinuria at 12 months compared to baseline values, while none of the patients with impaired renal function had more than 50% decrease in proteinuria.
Canakinumab, an IL-1 blocking agent, is not effective in decreasing proteinuria in FMF patients with already impaired renal functions and should be started early in the course of disease to prevent renal impairment.
卡那单抗是一种白细胞介素-1阻断药物，可降低发作的频率和严重程度，并降低秋水仙碱耐药/不耐受的家族性地中海热（FMF）患者的蛋白尿水平。然而，肾功能受损或保留的患者在蛋白尿减少和肾功能障碍进展方面对白细胞介素-1阻断疗法的反应是否不同尚不清楚，而这正是本研究的目的。
在开始使用卡那单抗之前，24小时尿蛋白排泄量>150mg/天且经活检证实为淀粉样变性的成年FMF受试者被分为两组，即肾功能保留组（肾小球滤过率≥60mL/分钟）和肾功能受损组（肾小球滤过率<60mL/分钟）。在这项横断面研究中，比较了两组患者蛋白尿和肾功能的反应。
本研究共纳入18例患者（11例肾功能保留，7例肾功能受损）。虽然两组患者在基线时以及开始使用卡那单抗6个月时的蛋白尿水平相似，但与肾功能受损的患者相比，肾功能保留的患者在12个月时的蛋白尿水平显著更低（分别为2462±1760mg/天和7065±3035mg/天，p=0.02）。与基线值相比，所有肾功能保留的患者在12个月时蛋白尿减少超过50%，而肾功能受损的患者中没有一例蛋白尿减少超过50%。
白细胞介素-1阻断剂卡那单抗对肾功能已受损的FMF患者降低蛋白尿无效，应在疾病进程早期开始使用以预防肾功能损害。
