Objective:
Treatment options for
patients with
rheumatoid arthritis on
maintenance hemodialysis with an inadequate response to
biologic agents have not been reported. In this
report, we describe two
patients who achieved remission
after treatment with peficitinib.
Methods:
Two 69- and 85-year-old
patients with
rheumatoid arthritis on
maintenance hemodialysis were previously treated with
biologics and started on peficitinib 100 mg/day after the
secondary failure of
biologics.
Discussion:
In the two cases presented here,
rheumatoid arthritis was almost in remission and there were no adverse events, although the
patients were switched to peficitinib after
secondary failure of the
biologic agents. Among
Janus kinase inhibitors, peficitinib has the lowest
renal excretion; therefore, its
administration in
patients on
dialysis is not contraindicated according to the
package insert in
Japan. The use of
biologic agents in
patients on
hemodialysis has been reported to be associated with a high
incidence of
infections; therefore, care should be taken to avoid
infections when administering
Janus kinase inhibitors.
Conclusion:
Janus kinase inhibitors with low
renal excretion, such as peficitinib, may be effective in
patients with
rheumatoid arthritis on
maintenance hemodialysis who have an inadequate response to
biologic agents.