Table II.
Dose modification of selected conventional synthetic disease modifying antirheumatic drug in renal insufficiency [18, 20–23, 25, 26, 28, 29, 31–35]
| csDMARD | Dose modification in renal insufficiency |
|---|---|
| Methotrexate | CrCl ≥ 60 ml/min – NDAR [18] CrCl 30–59 ml/min – reduction of dose by 50% [18] CrCl < 30 ml/min – contraindicated [18] |
| Hemodialysis: Avoid use. Cases of methotrexate toxicity (including death) have been reported [22, 23] Peritoneal dialysis: Avoid use. Cases of methotrexate toxicity (including death) have been reported [22, 23] CRRT: Reduction of dose by 50% [34] | |
| Leflunomide | “Mild” RI – NDAR [21] “Moderate and severe” RI – contraindicated [21] There are no specific dosage adjustments provided in the manufacturer’s labeling [21] |
| Hemodialysis: NDAR, use with caution [31, 32] Peritoneal dialysis: NDAR, use with caution [33] CRTT: ND, use with caution [33] | |
| Sulfasalazine | Caution should be exercised in patient with renal insufficiency [25] |
| Hemodialysis: Doses up to 1 g/day have been well tolerated, there is no efficacy or safety data available for doses > 1 g/day [26] Peritoneal dialysis: Doses up to 1 g/day have been well tolerated, there is no efficacy or safety data available for doses > 1 g/day [26] CRTT: ND | |
| Hydroxycholorquine | In short-term treatment – NDAR [29] In long-term treatment – DAR [29] Warning: Renal insufficiency can intensify the toxic effects on the retina and heart, which may necessitate dose reduction [29] |
| Hemodialysis: ND Peritoneal dialysis: ND CRTT: ND | |
| Chloroquine | Dosage adjustment provided in the manufacturer’s labeling refers only to treatment of malaria Caution should be exercised in RA patient with renal insufficiency [28] |
| Hemodialysis: Reduction of dose by 50% [20] Peritoneal dialysis: Reduction of dose by 50% [20] CRTT: NDAR [20] |
CrCl – creatinine clearance, CRTT – continuous renal replacement therapy, csDMARD – conventional synthetic disease modifying antirheumatic drugs, DAR – dose adjustment required, ND – no data, NDAR – no dose adjustment required, RI – renal insufficiency.