Efficacy and safety of interleukin-1 blockers in kidney transplant recipients with familial Mediterranean fever: a propensity score-matched cohort study.

Abstract

BACKGROUND:

Data on use of interleukin (IL)-1 blockers in kidney transplant recipients (KTRs) with familial Mediterranean fever (FMF) are very limited. We aimed to evaluate the efficacy and safety of anakinra and canakinumab in the transplantation setting.

METHODS:

In this retrospective cohort study, we included KTRs who suffered from AA amyloidosis caused by FMF and treated with anakinra or canakinumab (study group, n = 36). Using propensity score matching, we selected 36 patients without FMF or amyloidosis from our database of 696 KTRs as the control group. Primary outcomes were patient and graft survival. Biopsy-confirmed graft rejection, changes in estimated glomerular filtration rate (eGFR), high-sensitivity CRP (hsCRP), erythrocyte sedimentation rate (ESR), proteinuria and number of monthly attacks were secondary outcomes.

RESULTS:

All KTRs with FMF began IL-1 blocker therapy with anakinra and nine (25%) were switched to canakinumab. Overall death was more frequent in the study group (19.4% vs 0%) (P = .005); however, overall graft loss was comparable between study (27.8%) and control groups (36.1%) (P = .448). Five- and 10-year graft survival rates were significantly higher in the study group (94.4% and 83.3%, respectively) than in the control group (77.8% and 63.9%, respectively) (P = .014 and P < .001, respectively). Rejections were numerically lower in study group (8.3% vs 25%), but it did not reach to statistical significance (P = .058). When compared with the pre-treatment period, with IL-1 blockers, the number of attacks per month (P < .001), and eGFR (P = .004), hsCRP (P < .001) and ESR (P = .026) levels were lower throughout the follow-up, whereas proteinuria levels were not.

CONCLUSIONS:

Anakinra and canakinumab are effective in KTRs suffering from FMF; however, the mortality rate may be of concern.

• Authors: Safak Mirioglu, Ahmet Burak Dirim, Murat Bektas, Erol Demir, Yavuz Burak Tor, Yasemin Ozluk, Isin Kilicaslan, Ozgur Akin Oto, Yasemin Yalcinkaya, Yasar Caliskan, Bahar Artim-Esen, Halil Yazici, Murat Inanc, Aydin Turkmen, Ahmet Gul, Mehmet Sukru Sever
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 38 Issue 5 Pg. 1327-1336 (05 04 2023) ISSN: 1460-2385 [Electronic] England
• PMID: 36542475 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.

Chemical References

• Colchicine
• Interleukin 1 Receptor Antagonist Protein
• Interleukin-1
• C-Reactive Protein

Topics

• Humans
• Familial Mediterranean Fever (complications, drug therapy)
• Cohort Studies
• Colchicine
• Interleukin 1 Receptor Antagonist Protein (therapeutic use)
• Kidney Transplantation (adverse effects)
• Interleukin-1
• Retrospective Studies
• C-Reactive Protein
• Propensity Score
• Proteinuria (complications)