Tocilizumab Attenuates Anti-neutrophil Cytoplasmic Antibody-associated Nephritis Occurring during Abatacept and Adalimumab Therapy for Rheumatoid Arthritis

Yusuke Yoshimura; Shun Watanabe; Masayuki Yamanouchi; Daisuke Ikuma; Hiroki Mizuno; Akinari Sekine; Eiko Hasegawa; Tatsuya Suwabe; Kei Kono; Keiichi Kinowaki; Kenichi Ohashi; Yoshifumi Ubara; Naoki Sawa

doi:10.2169/internalmedicine.0858-22

CASE REPORTS

Tocilizumab Attenuates Anti-neutrophil Cytoplasmic Antibody-associated Nephritis Occurring during Abatacept and Adalimumab Therapy for Rheumatoid Arthritis

Yusuke Yoshimura, Shun Watanabe, Masayuki Yamanouchi, Daisuke Ikuma, Hiroki Mizuno, Akinari Sekine, Eiko Hasegawa, Tatsuya Suwabe, Kei Kono, Keiichi Kinowaki, Kenichi Ohashi, Yoshifumi Ubara, Naoki Sawa

Author information

Yusuke Yoshimura
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Shun Watanabe
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Masayuki Yamanouchi
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Daisuke Ikuma
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Hiroki Mizuno
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Akinari Sekine
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Eiko Hasegawa
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Tatsuya Suwabe
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Kei Kono
Department of Pathology, Toranomon Hospital, Japan
Keiichi Kinowaki
Department of Pathology, Toranomon Hospital, Japan
Kenichi Ohashi
Department of Pathology, Toranomon Hospital, Japan
Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
Yoshifumi Ubara
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan
Naoki Sawa
Nephrology Center, Toranomon Hospital Kajigaya, Japan
Okinaka Memorial Institute for Medical Research, Japan

Keywords: rheumatoid arthritis, TNF-α inhibitor, tocilizumab, ANCA-associated glomerulonephritis

JOURNAL OPEN ACCESS

2023 Volume 62 Issue 14 Pages 2099-2102

DOI https://doi.org/10.2169/internalmedicine.0858-22

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Abstract

We encountered an 86-year-old Japanese woman who presented with proteinuria (0.4 g/day) and hematuria (red blood cell sediment >100/high-power field), a decreased renal function (serum creatinine, 1.51 mg/dL), and elevated myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (231 IU/mL) during treatment of rheumatoid arthritis with abatacept (a cytotoxic T-lymphocyte-associated antigen 4 agent) and adalimumab (a tumor necrosis factor-α agent). A kidney biopsy showed pauci-immune necrotizing glomerulonephritis, and ANCA-associated vasculitis was diagnosed. Treatment with tocilizumab (an interleukin 6 receptor antibody) monotherapy resulted in the improvement of renal findings and normalization of rheumatoid arthritis disease activity and serum ANCA levels. Tocilizumab can also suppress ANCA-associated vasculitis.

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