Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan, 33305, Taiwan.
School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
BioDrugs. 2022 Sep;36(5):657-666. doi: 10.1007/s40259-022-00547-5. Epub 2022 Aug 22.
Patients with severe psoriasis are prone to deterioration of renal function. Whether biologics with potent anti-inflammatory action can prevent deterioration of renal function in psoriatic patients was unclear.
To investigate the effects of different biologics on renal function in patients with severe psoriasis.
By using the Chang Gung Research Database in Taiwan during 2006-2018, we analyzed the changes in renal function of psoriatic patients from 2 years before biologic treatments to baseline (start of biologic treatment) to after 2 years' treatment with different classes of biologics (anti-TNF, anti-IL-12/23, and anti-IL-17 agents). The renal function was evaluated by estimated glomerular filtration rate (eGFR) and the staging of chronic kidney disease (CKD). We further analyzed the risk factors of progression on the staging of CKD during biologics treatment.
We included 601 patients with severe psoriasis receiving continuous use of biologics for ≥ 2 years. We detected no significant differences between pre-biologic treatment with conventional systemic treatment and post-biologic treatment in the levels of eGFR and progression of CKD staging among psoriatic patients receiving different classes of biologics. Most patients (97.8%) remained at stable CKD stage, while progression of CKD stage over time occurred in 13 patients (2.2%), with seven treated with anti-TNF biologics and six treated with anti-IL-12/23 biologics. Of note, all 52 patients receiving anti-IL-17 biologics had stable CKD. Progression of CKD during biologics use was associated with lower baseline levels of eGFR, higher baseline CKD stage, older age, diabetes, and dyslipidemia. Further multiple logistic regression analysis showed diabetes as an independent factor for the deterioration of renal function during biologic treatment.
Biologic treatments failed to improve but did not worsen renal function of psoriatic patients during a 2-year follow-up period. Diabetes is an important risk factor for the deterioration of renal function.
严重银屑病患者易发生肾功能恶化。具有强大抗炎作用的生物制剂是否能预防银屑病患者肾功能恶化尚不清楚。
探讨不同生物制剂对严重银屑病患者肾功能的影响。
利用台湾长庚研究数据库，我们分析了 2006 年至 2018 年间接受生物制剂治疗的银屑病患者在开始生物制剂治疗前 2 年至基线（生物制剂治疗开始时）至接受不同类别的生物制剂（抗 TNF、抗 IL-12/23 和抗 IL-17 制剂）治疗 2 年后肾功能的变化。通过估算肾小球滤过率（eGFR）和慢性肾脏病（CKD）分期来评估肾功能。我们进一步分析了生物制剂治疗期间 CKD 分期进展的危险因素。
我们纳入了 601 例连续使用生物制剂治疗≥2 年的严重银屑病患者。我们发现，接受不同类别的生物制剂治疗的银屑病患者，在开始生物制剂治疗前的常规系统治疗和开始生物制剂治疗后的 eGFR 水平以及 CKD 分期进展方面，无显著差异。大多数患者（97.8%）的 CKD 分期保持稳定，而有 13 例（2.2%）患者的 CKD 分期随时间进展，其中 7 例接受抗 TNF 生物制剂治疗，6 例接受抗 IL-12/23 生物制剂治疗。值得注意的是，所有 52 例接受抗 IL-17 生物制剂治疗的患者 CKD 均保持稳定。生物制剂使用期间 CKD 进展与基线 eGFR 水平较低、基线 CKD 分期较高、年龄较大、糖尿病和血脂异常有关。进一步的多因素逻辑回归分析显示，糖尿病是生物制剂治疗期间肾功能恶化的独立危险因素。
在 2 年的随访期间，生物制剂治疗未能改善银屑病患者的肾功能，但也未使其恶化。糖尿病是肾功能恶化的重要危险因素。
