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A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients

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Abstract

In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy—based on creatinine level, proteinuria and disease activity—was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.

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Authors and Affiliations

  1. Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey

    Ömer Nuri Pamuk & Salim Dönmez

  2. Division of Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey

    Umut Kalyoncu & Levent Kılıç

  3. Division of Rheumatology, Ege University Medical Faculty, Izmir, Turkey

    Kenan Aksu & Özün Bayındır

  4. Division of Rheumatology, Ankara Numune Research and Education Hospital, Ankara, Turkey

    Ahmet Omma & Orhan Küçükşahin

  5. Division of Rheumatology, Uludag University Medical Faculty, Bursa, Turkey

    Yavuz Pehlivan & Mustafa Ferhat Öksüz

  6. Division of Rheumatology, Medipol University, Istanbul, Turkey

    Yonca Çağatay

  7. Division of Rheumatology, Sütçü İmam University Medical Faculty, Kahramanmaraş, Turkey

    Gözde Yıldırım Çetin

  8. Hatay State Hospital, Hatay, Turkey

    Rıdvan Mercan

  9. Division of Rheumatology, Kocaeli University Medical Faculty, Kocaeli, Turkey

    Ayşe Çefle

  10. Van Research and Education Hospital, Van, Turkey

    Fatih Yıldız

  11. Division of Rheumatology, Pamukkale University Medical Faculty, Denizli, Turkey

    Ayşe Balkarlı & Veli Çobankara

  12. Division of Rheumatology, Fatih Sultan Mehmet Research and Education Hospital, Istanbul, Turkey

    Necati Çakır

  13. Division of Rheumatology, Gaziantep University Medical Faculty, Gaziantep, Turkey

    Bünyamin Kısacık & Ahmet Mesut Onat

  14. Division of Rheumatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey

    Mehmet Sayarlıoğlu

  15. Division of Rheumatology, Gazi University Medical Faculty, Ankara, Turkey

    Mehmet Akif Öztürk

  16. Division of Hematology, Trakya University Medical Faculty, Edirne, Turkey

    Gülsüm Emel Pamuk

  17. Division of Rheumatology, Dokuz Eylül University Medical Faculty, Edirne, Turkey

    Nurullah Akkoç

Authors
  1. Ömer Nuri Pamuk
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  2. Umut Kalyoncu
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  3. Kenan Aksu
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  7. Orhan Küçükşahin
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  9. Gözde Yıldırım Çetin
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  14. Ayşe Balkarlı
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  15. Levent Kılıç
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  16. Necati Çakır
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  17. Bünyamin Kısacık
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  18. Mustafa Ferhat Öksüz
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  19. Veli Çobankara
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  20. Ahmet Mesut Onat
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  21. Mehmet Sayarlıoğlu
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  22. Mehmet Akif Öztürk
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  23. Gülsüm Emel Pamuk
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  24. Nurullah Akkoç
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Corresponding author

Correspondence to Ömer Nuri Pamuk.

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Conflict of interest

Ömer Nuri Pamuk, Umut Kalyoncu, Kenan Aksu, Ahmet Omma, Yavuz Pehlivan, Yonca Çağatay, Orhan Küçükşahin, Salim Dönmez, Gözde Yıldırım Çetin, Rıdvan Mercan, Özün Bayındır, Ayşe Çefle, Fatih Yıldız, Ayşe Balkarlı, Levent Kılıç, Necati Çakır, Bünyamin Kısacık, Mustafa Ferhat Öksüz, Veli Çobankara, Ahmet Mesut Onat, Mehmet Sayarlıoğlu, Mehmet Akif Öztürk, Gülsüm Emel Pamuk and Nurullah Akkoç declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Because of retrospective study design, informed consent was not obtained from all individual participants included in the study.

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Pamuk, Ö.N., Kalyoncu, U., Aksu, K. et al. A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients. Rheumatol Int 36, 945–953 (2016). https://doi.org/10.1007/s00296-016-3500-9

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  • DOI: https://doi.org/10.1007/s00296-016-3500-9

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