TOPLINE:

Having rheumatoid arthritis (RA) and reduced (vs preserved) kidney function made remission after drug therapy less likely, a cohort study found.

METHODOLOGY:

• Researchers used registry data to evaluate the efficacy of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with RA with reduced or preserved kidney function.
• Researchers analyzed 12,123 biologic and targeted synthetic DMARD treatment initiations in 9601 patients (median age, 59.0 years; 80.2% female; 81.7% non-Hispanic White patients).
• Patients had to have moderate or high disease activity at drug initiation, and reduced estimated glomerular filtration rate (eGFR; < 60 mL/min/1.73 m²) and preserved eGFR (≥ 60 mL/min/1.73 m²) rates were calculated.
• The primary outcome was achieving Clinical Disease Activity Index (CDAI)-based remission (score ≤ 2.8).
• Secondary outcomes were achieving CDAI-based remission or low disease activity (score > 2.8-10.0) and retention and discontinuation of DMARDs.

TAKEAWAY:

• CDAI-based remission occurred in 27.9% vs 19.4% of 10,857 vs 1266 treatment initiations for patients with preserved eGFR vs treatment initiations for those with reduced eGFR.
• Reduced eGFR was associated with a lower likelihood of attaining CDAI-based remission than preserved eGFR (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.66-0.88).
• Reduced eGFR was also associated with fewer patients attaining CDAI-based remission or low disease activity (aHR, 0.89; 95% CI, 0.82-0.97).
• Rates of treatment discontinuation were comparable between patients with reduced eGFR (49.2%) vs preserved eGFR (52.1%), and overall retention rates of biologic and targeted synthetic DMARDs were the same.

IN PRACTICE:

The study results “support the possibility of a direct link between reduced kidney function and reduced treatment response to biological and targeted synthetic DMARDs,” the study authors wrote. They added that the findings “might underscore the prognostic relevance of kidney function in the management of patients with rheumatoid arthritis.”

SOURCE:

The study was led by Sho Fukui, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston. It was published online on April 22, 2026, in The Lancet Rheumatology.

LIMITATIONS:

Approximately 17% of patients were excluded because of missing baseline eGFR data. The typical registry visit interval of 6 months precluded assessment of disease activity immediately after initiation of biologics and targeted synthetic DMARDs. Information on dialysis, transplants, and proteinuria was not available, which could lead to bias and limit the evaluation of chronic kidney disease severity based on albuminuria categories. The study mostly included non-Hispanic White individuals, thereby affecting the generalizability of the findings.

DISCLOSURES:

The study received support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Some authors disclosed receiving research grant support or salary support to their institution, consulting fees, and/or honoraria from multiple pharmaceutical companies. One author reported participation on advisory boards and receipt of royalties from UpToDate. Two authors reported employment with Thermo Fisher Scientific and holding stock from the company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.