Nishimura Akito, Tateiwa Masayuki, Tajima Shuuitirou, Tada Takuya
Depratment of Orthopedics, Shimizu Welfare Hospital, 578-1 Ihara-cho, Shimizu-ku, Shizuoka City, Shizuoka 424-0114, Japan.
J Rural Med. 2022 Jul;17(3):193-195. doi: 10.2185/jrm.2022-005. Epub 2022 Jul 1.
Treatment options for patients with rheumatoid arthritis on maintenance hemodialysis with an inadequate response to biologic agents have not been reported. In this report, we describe two patients who achieved remission after treatment with peficitinib. Two 69- and 85-year-old patients with rheumatoid arthritis on maintenance hemodialysis were previously treated with biologics and started on peficitinib 100 mg/day after the secondary failure of biologics. In the two cases presented here, rheumatoid arthritis was almost in remission and there were no adverse events, although the patients were switched to peficitinib after secondary failure of the biologic agents. Among Janus kinase inhibitors, peficitinib has the lowest renal excretion; therefore, its administration in patients on dialysis is not contraindicated according to the package insert in Japan. The use of biologic agents in patients on hemodialysis has been reported to be associated with a high incidence of infections; therefore, care should be taken to avoid infections when administering Janus kinase inhibitors. Janus kinase inhibitors with low renal excretion, such as peficitinib, may be effective in patients with rheumatoid arthritis on maintenance hemodialysis who have an inadequate response to biologic agents.
对于维持性血液透析且对生物制剂反应不佳的类风湿关节炎患者，尚未有相关治疗方案的报道。在本报告中，我们描述了两名接受培非替尼治疗后病情缓解的患者。两名分别为69岁和85岁的维持性血液透析类风湿关节炎患者，此前接受过生物制剂治疗，在生物制剂二次治疗失败后开始服用培非替尼，剂量为每日100毫克。在本报告的这两个病例中，尽管患者在生物制剂二次治疗失败后改用培非替尼，但类风湿关节炎几乎完全缓解，且未出现不良事件。在Janus激酶抑制剂中，培非替尼的肾脏排泄率最低；因此，根据日本的药品说明书，在透析患者中使用该药并无禁忌。据报道，血液透析患者使用生物制剂会导致感染发生率较高；因此，在使用Janus激酶抑制剂时应注意预防感染。肾脏排泄率较低的Janus激酶抑制剂，如培非替尼，可能对维持性血液透析且对生物制剂反应不佳的类风湿关节炎患者有效。
