Recent research has unveiled a concerning trend among patients with rheumatic diseases who undergo kidney transplantation and receive biologic disease-modifying anti-rheumatic drugs (bDMARDs). Published in Clinical Rheumatology, the findings indicate a significantly heightened risk of severe infections in this patient population, raising questions about both treatment and post-operative care.

Lead investigator Tuba Demirci Yildirim, MD, MSc, a physician specializing in internal medicine and rheumatology at Dokuz Eylül University and Ízmir City Hospital in Turkey, emphasized a critical knowledge gap. "There is a significant knowledge gap regarding the adverse events associated with bDMARDs in rheumatic patients post-transplant, especially given their concurrent use of immunosuppressives to prevent kidney rejection," Yildirim stated. This comprehensive study aimed to close that gap by assessing the rates of severe infections in patients utilizing bDMARDs after transplantation.

In a multicenter, retrospective study, Yildirim and her research team analyzed data from 38 kidney transplant recipients suffering from various rheumatic conditions. The cohort, with a median age of 40.5 years, featured diverse rheumatic diseases, including Familial Mediterranean Fever (FMF) at 57.9%, spondyloarthritis (SpA) at 23.7%, and rheumatoid arthritis (RA) at 7.9%. Notably, 68.4% of the patients were prescribed IL-1 inhibitors, while 31.6% received anti-TNF therapy.

The researchers discovered that approximately 52.6% of participants experienced severe infections, with an incidence rate of 26.2 severe infections per 100 patient years. Urinary tract infections and pneumonia dominated the infection types, accounting for 43.5% and 30.8% of cases, respectively. Disturbingly, four patients (11%) lost their lives due to infection-related complications, including fatalities from COVID-19.

This study also highlighted that there were no significant differences in gender, pre-transplant biological therapy, or type of biological therapy between those who developed infections and those who did not, indicating that the risk may be intrinsic to the bDMARD treatment combined with post-transplant immunosuppression.

Yildirim and her team noted several limitations, such as the study's retrospective design and the lack of a control group, which should be addressed in future research. They underscored the need for vigilant infection monitoring and personalized management strategies to mitigate complications arising from bDMARD therapy in vulnerable patient populations.

Highlighting the critical nature of monitoring, other studies have found that systematic multimorbidity screening in patients with inflammatory rheumatic diseases (IRD) significantly enhanced the use of preventive medications and decreased hospital admissions. This trend has prompted calls for more resources to be allocated for screening practices.

Lead investigator Claire Immediato Daien from the Centre Hospitalier Universitaire de Montpellier in France, found that patients engaged in the multimorbidity screening reached health endpoints at a notably higher rate than non-exposed patients. This evidence supports the potential benefits of systematic screening as a proactive means to improve patient outcomes.

In summary, this alarming research reveals the urgent need for better awareness and expert-guided strategies aimed at minimizing infection risks for kidney transplant patients on bDMARDs. With further investigations warranted, healthcare providers are urged to adopt a more cautious approach to treatment in this complex and vulnerable patient group.