#4-38E. Navigating RA Targets in CKD: Efficacy and Tolerance of b/tsDMARDs (LancetRheumatol, 2026)

How do we optimize rheumatoid arthritis (RA) treatment in patients with chronic kidney disease (CKD) when standard targets feel out of reach? This episode explores a large, multicenter, prospective cohort study evaluating the effectiveness and persistence of biological and targeted synthetic DMARDs (b/tsDMARDs) in RA patients with compromised renal function. Utilizing the CorEvitas registry, the authors demonstrated that while b/tsDMARDs are generally well-tolerated, patients with an eGFR below 60 mL/min/1.73 m² have a significantly lower likelihood of achieving Clinical Disease Activity Index (CDAI)-based remission compared to those with preserved kidney function. The critical takeaway is that despite maintained drug persistence, achieving standard remission is more challenging in this high-risk population, highlighting the need for adjusted, individualized "Treat-to-Target" goals. However, when appraising these findings, clinicians must consider the study's observational design, which leaves room for unmeasured socioeconomic confounders and relies on multiple imputation for missing baseline data such as CRP. For practicing physicians, this evidence underscores the vital importance of recalibrating clinical expectations and tailoring management strategies to optimize care for RA patients with comorbid CKD.

Citation: Fukui S, Solomon DH, et al. Effectiveness and persistence of biological and targeted synthetic treatment in patients with rheumatoid arthritis and chronic kidney disease: a multicentre, prospective cohort study. The Lancet Rheumatology. 2026. DOI: https://doi.org/10.1016/S2665-9913(26)00046-9

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.