Akyol Lütfi, Balcı Mehmet Ali
Division of Rheumatology, Department of Internal Medicine, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Eur J Rheumatol. 2022 Jan;9(1):31-35. doi: 10.5152/eurjrheum.2021.20230.
To retrospectively evaluate the effect of anti-tumor necrosis factor-alpha (TNF-α) drugs on hepatic and renal functions in patients with ankylosing spondylitis (AS).
A total of 148 patients (89 male, 59 female) who were followed up for a minimum duration of 1 year on newly started anti TNF-α therapy were included. Patients were divided into 5 groups based on the TNF-α treatment received. Initially, pre-treatment BASDAI (Bath Ankylosing Spondylitis Disease Activity) scores and laboratory results were compared between the groups before the treatment. Also, ESR (erythrocyte sedimentation rate), C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine values were compared before treatment and at 3, 6, and 12 months after treatment. Also presence of hematuria and proteinuria was examined.
Of the overall group, 68 (45%), 33 (22%), 23 (15%), 18 (12%), and 6 (4%) received golimumab, certolizumab, etanercept, adalimumab, and infliximab. Baseline demographic characteristics, disease activity scores, and laboratory parameters were comparable between the groups (P > .05). There was a significant decline in BASDAI scores from baseline at 12 months (pre-treatment 5.24 ± 0.5, 3.01 ± 0.48 post-treatment at 12 months, P < .001). Although there was an increase in AST and ALT from baseline to 3, 6, and 12 months of treatment, the values remained within normal range (P > .05). Also, there were no significant changes in mean creatinine levels (P > .05). There were no correlations between disease activity parameters (ESR, CRP, and BASDAI) and hepatic and renal functions (P > .05).
No hepatotoxicity or nephrotoxicity were found in association with the use of anti-TNF-α agents over a 1 year period. However, hepatotoxicity and nephrotoxicity are among known adverse effects of these agents. Based on the existing literature data, routine monitoring of patients in terms of potential hepatic and renal toxicity before and after treatment remains a valid recommendation in clinical practice.
回顾性评估抗肿瘤坏死因子-α（TNF-α）药物对强直性脊柱炎（AS）患者肝肾功能的影响。
纳入148例（男89例，女59例）新开始接受抗TNF-α治疗且随访至少1年的患者。根据接受的TNF-α治疗将患者分为5组。首先，比较治疗前各组间的BASDAI（巴斯强直性脊柱炎疾病活动度）评分和实验室检查结果。此外，比较治疗前及治疗后3、6和12个月时的红细胞沉降率（ESR）、C反应蛋白（CRP）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、尿素和肌酐值。同时检查血尿和蛋白尿的情况。
在整个研究组中，68例（45%）、33例（22%）、23例（15%）、18例（12%）和6例（4%）分别接受了戈利木单抗、赛妥珠单抗、依那西普、阿达木单抗和英夫利昔单抗治疗。各组间的基线人口统计学特征、疾病活动度评分和实验室参数具有可比性（P>.05）。12个月时BASDAI评分较基线有显著下降（治疗前5.24±0.5，治疗12个月后3.01±0.48，P<.001）。虽然治疗3、6和12个月时AST和ALT较基线有所升高，但这些值仍在正常范围内（P>.05）。此外，平均肌酐水平无显著变化（P>.05）。疾病活动度参数（ESR、CRP和BASDAI）与肝肾功能之间无相关性（P>.05）。
在1年的时间里，未发现使用抗TNF-α药物存在肝毒性或肾毒性。然而，肝毒性和肾毒性是这些药物已知的不良反应之一。根据现有文献数据，在临床实践中，对患者治疗前后潜在的肝毒性和肾毒性进行常规监测仍然是一项有效的建议。
