Ab0418 interstitial Lung Disease in Patients With Rheumatoid Arthritis Treated With Tofacitinib

Abstract

Background:The presence of interstitial lung disease (ILD) is a common extra-articular manifestation in patients diagnosed with Rheumatoid Arthritis (RA), dyspnea being its cardinal symptom. Several of the drugs commonly used to treat this condition, such as TNF inhibitors (anti-TNF) and Disease Modifying Antirheumatic Drugs (DMARDs), have been implicated in the development or exacerbation of ILD. In regard to Tofacitinib, results of post hoc analysis of its pivotal and extension studies report a numerically lower ILD incidence rate in the group that received this drug compared with placebo.Objectives:To describe the evolution of dyspnea, spirometric parameters, DLCO and high resolution computed tomography (HRCT) findings in patients with RA diagnosis with associated PID who received Tofacitinib for a period of 12 months.Methods:Patients with a diagnosis of RA who fulfilled criteria ACR 1987/ACR-EULAR 2010, with interstitial lung disease previously diagnosed from clinical findings, spirometry and/or HRCT were included. Tofacitinib was used in dose of 10 mg/day orally. Design: Descriptive, retrospective, multicentric study. The following variables were analyzed: change at 12 months from baseline in the degree of dyspnea (according to the modified scale of dyspnea MMRC), forced vital capacity (FVC), DLCO and findings in HRCT. Continuous variables were reported as mean and standard deviation or median and interquartile range as appropriate. The categorical variables were reported as percentages.Results:Fifteen patients were included. 60% (n: 9) were women. The mean age was 64.4 years (± 10.92). The median time of evolution of RA was 9 years (IQR: 4-40). The median time of evolution of interstitial lung disease was 4 years (IQR: 1-24).13% (n: 2) of the patients were receiving methotrexate (MTX) at the time of evaluation, 60% (n: 9) of the patients had previously received it. 80% (n: 12) had previously received DMARD different from MTX. 33% of the patients (n: 5) had received previous biological treatment. All patients received tofacitinib at a dose of 10mg/day. 47% of patients (n = 7) received tofacitinib monotherapy and 53% (n = 8) received it combined with DMARDsc. 27% (n: 4) of the patients had grade 3-4 dyspnea at baseline.Improvement in the dyspnea scale was observed in 8 patients, while in the rest, it remained stable. The forced vital capacity (FVC) at baseline was <80% in 5 patients and> 80% in 2 patients. At 12 months, 4 patients achieved a FVC> 80%.The average of DLCO at baseline was 45.6 (± 18.84), with an improvement of 30% at 12 months in 4 patients. No progression of the disease was observed in the HRCT at 12 months in any of the patients evaluated.Conclusion:The present preliminary study was performed with patients of daily practice, not being available in all cases, the corresponding respiratory functional examinations. However, despite these limitations, none of the patients showed worsening of dyspnea, with improvement in some patients. Regarding respiratory functional examinations and DLCO, not only...

Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis

“…Few real-life data are up to now available. Among 15 RA-ILD patients treated with tofacitinib, none showed worsening of dyspnoea, while improvement was reported in some cases; moreover, respiratory function and DLCO remained stable in the majority of subjects evaluated, while 4 patients improved [ 18 ].…”

Immunmodulation bei autoimmunen interstitiellen Lungenerkrankungen

“…Durch diese Daten ermutigt wurde in einer prospektiven, nicht verblindeten, monozentrischen Studie Tofacitinib bei 18 Patienten mit früher Anti-MDA5-ADM-ILD untersucht; sie ergab eine 6-Monats-Überlebensrate von 100% im Vergleich zu 78% bei nach Therapiestandard behandelten historischen Kontrollen, begleitet von Verbesserungen der FVC und DLCO [61]. Bei RA wird diese Therapie weithin angewendet, obwohl bisher nur vorläufige retrospektive unkontrollierte Daten zu 15 Patienten vorliegen, die von einer signifikanten Verbesserung der DLCO und einer Stabilisierung der Fibroseausdehnung in der hochauflösenden Computertomografie (CT) nach 12 Monaten berichten [62]. In der kürzlich begonnenen randomisierten Studie PULMORA (NCT04311567) sollen die Auswirkungen auf die Entwicklung der ILD bei RA untersucht werden.…”

Lunge – Interstitielle Lungenerkrankungen in der Rheumatologie

“…Für den JAK-Inhibitor Tofacitinib gibt es Wirksamkeitshinweise bei ILD im Rahmen einer anti-MDA5 positiven amyopathischen Dermatomyositis und bei RA [35][36][37]. Für eine verlässliche Beurteilbarkeit fehlt zum gegenwärtigen Zeitpunkt jedoch die Datenbasis.…”