Renal toxicity associated with disease-modifying antirheumatic drugs used for the treatment of rheumatoid arthritis*,**,*,★★

https://doi.org/10.1053/sarh.2000.16641Get rights and content

Abstract

Objective: To provide a review of the renal toxicity of disease-modifying antirheumatic drugs (DMARDs) currently used for the treatment of rheumatoid arthritis. Methods: Papers in American and European medical journals related to renal toxicity of DMARDs used for the treatment of rheumatoid arthritis were reviewed. Specific DMARDs reviewed were cyclosporine, gold, D-penicillamine, methotrexate, azathioprine, antimalarials, sulfasalazine, leflunomide, etanercept, infliximab, and DMARD combination therapy. Results: The renal toxicity of DMARDs varies widely. Cyclosporine, gold, and D-penicillamine all have a serious potential for renal side effects, particularly in the elderly or in patients with compromised renal function. Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the potential for renal damage. In contrast, methotrexate, azathioprine, antimalarials, sulfasalazine, leflunomide, etanercept, and infliximab have relatively little renal toxicity. Conclusions: The potential for renal toxicity should always be considered when determining which DMARD to use for RA therapy. DMARDs that combine efficacy with negligible renal adverse effects should be used for the treatment of patients susceptible to DMARD-associated renal damage. Semin Arthritis Rheum 30:196-208. Copyright © 2000 by W.B. Saunders Company

References (75)

  • G Wiederrecht et al.

    The mechanism of action of FK-506 and cyclosporin A

    Ann NY Acad Sci

    (1993)
  • ME Weinblatt et al.

    Cyclosporin A treatment of refractory rheumatoid arthritis

    Arthritis Rheum

    (1987)
  • BA Dijkmans et al.

    Effects of cyclosporin on serum creatinine in patients with rheumatoid arthritis

    Eur J Clin Pharmacol

    (1987)
  • DE Yocum et al.

    Cyclosporin A in severe, treatment-refractory rheumatoid arthritis

    Ann Intern Med

    (1988)
  • International Kidney Biopsy Registry of Cyclosporin (Sandimmune) in Autoimmune Diseases. Renal morphology after cyclosporin A therapy in rheumatoid arthritis patients

    Br J Rheumatol

    (1993)
  • G Feutren et al.

    Risk factor for cyclosporine-induced nephropathy in patients with autoimmune diseases. International Kidney Biopsy Registry of Cyclosporine in Autoimmune Diseases

    N Engl J Med

    (1992)
  • S Sund et al.

    Morphological and functional renal effects of long-term low-dose cyclosporin A treatment in patients with rheumatoid arthritis

    Clin Nephrol

    (1994)
  • J Rodriguez et al.

    Renal biopsy findings and follow-up of renal function in rheumatoid arthritis patients treated with cyclosporin A: an update form the International Kidney Biopsy Registry

    Arthritis Rheum

    (1996)
  • RB Landewe et al.

    Longterm, low dose cyclosporine in patients with rheumatoid arthritis: renal function loss without structural nephropathy

    J Rheumatol

    (1996)
  • M Dougados et al.

    Cyclosporin in rheumatoid arthritis: a double blind, placebo-controlled study in 52 patients

    Ann Rheum Dis

    (1988)
  • R Madhok et al.

    A study of the long-term efficacy and toxicity of cyclosporin A in rheumatoid arthritis

    J Rheumatol

    (1991)
  • RBM Landewe et al.

    Cyclosporin in common clinical practice: an estimation of the benefit/risk ratio in patients with rheumatoid arthritis

    J Rheumatol

    (1994)
  • O Forre et al.

    Radiologic evidence of disease modification in rheumatoid arthritis patients treated with cyclosporine: results of a 48-week multicenter study comparing low-dose cyclosporine and placebo

    Arthritis Rheum

    (1994)
  • JJ Cush et al.

    US consensus guidelines for the use of cyclosporin A in rheumatoid arthritis

    J Rheumatol

    (1999)
  • G Gardner et al.

    Disease-modifying antirheumatic drugs: potential effects in older patients

    Drugs Aging

    (1998)
  • GV Raman et al.

    Modifying effects of amlodipine on cyclosporin A-induced changes in renal function in patients with psoriasis

    J Hypertens

    (1998)
  • CL. Hall

    Gold nephropathy

    Nephron

    (1988)
  • CL Hall et al.

    The natural course of gold nephropathy: a long-term study of 21 patients

    Br Med J

    (1987)
  • CL. Hall

    The natural course of gold and penicillamine nephropathy: a longterm study of 54 patients

    Adv Exp Med Biol

    (1989)
  • B Samuels et al.

    Membranous nephropathy in patients with rheumatoid arthritis: relationship to gold therapy

    Medicine

    (1977)
  • H Helin et al.

    Mild mesangial glomerulopathy: a frequent finding in patients with hematuria or proteinuria

    Nephron

    (1986)
  • WF Kean et al.

    Long term chrysotherapy

    Arthritis Rheum

    (1979)
  • DC Nelson et al.

    Renal vein thrombosis associated with nephrotic syndrome and gold therapy in rheumatoid arthritis

    South Med J

    (1979)
  • FE Husserl et al.

    Gold nephropathy in juvenile rheumatoid arthritis

    Am J Dis Child

    (1979)
  • B Vernon-Roberts et al.

    Selective concentration and localization of gold in macrophages of synovial and other tissues during and after chrysotherapy in rheumatoid patients

    Ann Rheum Dis

    (1976)
  • RWE Clarkson et al.

    Complement C4 null alleles as a marker of gold or D-penicillamine toxicity in the treatment of rheumatoid arthritis

    Br J Rheumatol

    (1992)
  • GC. Bernhard

    Auranofin therapy in rheumatoid arthritis

    J Lab Clin Med

    (1982)
  • Cited by (0)

    *

    Michael H. Schiff, MD: Professor of Clinical Medicine, University of Colorado School of Medicine, Denver, CO; Andrew Whelton, MD, DSc: Professor of Medicine Adjunct, Johns Hopkins University School of Medicine, Baltimore, MD.

    **

    Dr. Schiff is a consultant for Amgen, Aventis Pharma, Bayer, Bristol-Myers Squibb, Centocor, Fujisawa, Genelabs, Hoffman-La Roche, Immunex, Eli Lilly, Merck, Neurobiological Tech, Inc., Novartis Pharmaceuticals, Parke-Davis, Pfizer Inc, Proctor & Gamble, Searle, SmithKline Beecham, and Wyeth-Ayerst.

    *

    Dr. Whelton is a consultant for Aventis Pharma, Pfizer Inc., Pharmacia, and Searle.

    ★★

    Address correspondence and reprint requests to Michael H. Schiff, MD, Denver Arthritis Clinic, 4545 East 9th St, Suite 510, Denver, CO 80220. E-mail: [email protected]

    View full text