BRIEF OBSERVATION Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists Antonio Fernández-Nebro, MD, PhD, a Eva Tomero, MD, b Vera Ortiz-Santamaría, MD, c María Carmen Castro, PhD, d Alejandro Olivé, MD, PhD, c Manuel de Haro, MD, PhD, a Rosa García-Vicuña, MD, PhD, e María Victoria González-Mari, MD, PhD, a Armando Laffón, MD, PhD, e Rosario García-Vicuña, MD, PhD a a Rheumatology Section, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Spain; b Rheumatology Service, Hospital General de Segovia, Segovia, Spain; c Rheumatology Section, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; d Rheumatology Service, Hospital Universitario Reina Sofía, Córdoba, Spain; e Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain. Secondary amyloidosis occurs in 5% of patients with poorly controlled, slow-developing chronic inflammatory diseases, mainly rheumatoid arthritis or spondyloarthropa- thies. 1 Unless the activity of the underlying disease can be effectively controlled, the development of secondary amy- loidosis is associated with a poor prognosis and reduces the survival rate of these patients. 2 Until now, therapeutic ap- proaches have yielded poor results, with the exception of alkylating agents. However, the high toxicity of these drugs often complicates patient management. Tumor necrosis fac- tor-alpha antagonists are changing the clinical course of some inflammatory diseases, but experience in patients with secondary amyloidosis is scarce. 3-8 The aim of our study was to assess the efficacy and safety of anti-tumor necrosis factor agents in a series of 25 Spanish patients with amy- loidosis secondary to a rheumatic disease. Methods From January 2001 to December 2003, 25 patients with secondary amyloidosis were treated and prospectively fol- lowed up in 5 Spanish hospitals. Informed consent was obtained from patients. Local Ethics Committee, Hospital and Spanish Drug Agency and Health Administration ap- provals were obtained as required. Etanercept (Enbrel, Wyeth Laboratories, Madrid, Spain) was given subcutane- ously (25 mg twice weekly) to 3 patients, and infliximab (Remicade, Schering-Plough, SA, Madrid, Spain) was in- fused (4.2  1.2 mg/kg, mean  standard deviation [SD]) to the remaining patients at weeks 0, 2, and 6, and then every 8 weeks. The dose or frequency of infusion was increased in 13 patients (59%) when clinically indicated. The diagnosis of secondary amyloidosis was confirmed his- tologically in all cases (36% by renal biopsy). Six of our patients were previously reported as a letter to the editor. 9 In the present manuscript, the data from these patients were updated and the clinical records from 19 new patients were added. Patient’s sex, age, underlying inflammatory disease, du- ration of underlying disease and amyloidosis, procedure for amyloidosis diagnosis, organs or systems involved, dose and duration of anti-tumor necrosis factor therapy, adverse Requests for reprints should be addressed to Antonio Fernández-Nebro, MD, PhD, Servicio de Reumatología, Hospital Universitario Carlos Haya, Secretaría de la 5° planta, Pabellón A Avenida de Carlos Haya s/n, Málaga 29010, Spain. E-mail address: afn@mail.cofaran.es. 0002-9343/$ -see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2005.01.028 The American Journal of Medicine (2005) 118, 552–556