Which biologics for severe RA are safe in CKD4?

Most biologics, such as monoclonal antibodies, are large proteins that are not cleared by the kidneys, and thus, no dose adjustment is needed for renal impairment, and can be used in advanced stages of CKD.

Keep in mind among tsDMARDs that the JAK inhibitors do have a renal dosing adjustment require...

TNF blockers are usually safe in patients with CKD due to less renal toxicity.