Abatacept in monotherapyvscombined in interstitial lung disease of rheumatoid arthritis—multicentre study of 263 Caucasian patients

Abstract

Objective To assess the efficacy and safety of abatacept (ABA) in monotherapy (ABAMONO) versus combined-ABA, ABA plus methotrexate (ABAMTX) or ABA plus non-MTX conventional-DMARDs (ABANON-MTX), in Rheumatoid Arthritis (RA) patients with Interstitial Lung Disease (ILD) (RA-ILD). Methods Restrospective multicenter study of RA-ILD Caucasian patients treated with ABA. We analyzed in the three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcome variables: a) Dyspnea b) FVC and DLCO c) chest HRCT, d) DAS28-ESR, e) corticosteroid-sparing effect, f) ABA retention and side-effects. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the three groups. Results We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABAMONO (n = 111), ABAMTX (n = 46) and ABANON-MTX (n = 106)]. At baseline, ABAMONO patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). At that time, there were no statistically significant differences in sex, seropositivity, ILD patterns, FVC and DLCO or disease duration. Following treatment, in all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnoea, chest-HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in the group on combined-ABA (ABAMTX or ABANON-MTX). However, in the multivariable analysis, there were no differences in any outcome variables between the three groups. Conclusion In Caucasian individuals with RA-ILD, ABA in monotherapy or combined with MTX or with other conventional-DMARDS seems to be equally effective and safe. However, a corticosteroid-sparing effect is only observed with combined-ABA.

Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020

“…Therapy with abatacept is slowly increasing. Current evidence indicates abatacept as a feasible treatment option for stabilising ILD in many and improving it in some patients11 23 24 with contradictory results on MTX co-medication 11 25. The comparison of the medication with patients with RA without ILD reflects quite well the tendency to increasingly prescribe abatacept, rituximab, tocilizumab or even JAK inhibitors instead of TNF inhibitors when ILD is present.…”

Interstitielle Lungenbeteiligung bei der rheumatoiden Arthritis

“…Bislang nur als Poster auf dem EULAR 2018 präsentiert konnte im folgenden eine Verbesserung der CT-Morphologie unter Abatacept und Rituximab und nicht unter Tocilizumab gezeigt werden [35]. Zuletzt wurden in einer größeren multizentrischen (ebenfalls) retrospektiven Analyse an 263 Patienten die vorherigen Ergebnisse bestätigt und gezeigt, dass sich unter Abatacept 75 % der ILD-RA stabilisiert und in einem geringen Teil sogar verbessert [36]. Die Kombination mit MTX hatte keinen relevanten Einfluss auf den Verlauf der ILD [36].…”

“…Zuletzt wurden in einer größeren multizentrischen (ebenfalls) retrospektiven Analyse an 263 Patienten die vorherigen Ergebnisse bestätigt und gezeigt, dass sich unter Abatacept 75 % der ILD-RA stabilisiert und in einem geringen Teil sogar verbessert [36]. Die Kombination mit MTX hatte keinen relevanten Einfluss auf den Verlauf der ILD [36].…”

Perspective Chapter: Pulmonary System and Sjogren’s Syndrome

“…This way it blocks costimulatory interaction of CD80/CD86 receptors with the T cell receptor (CD28) necessary for T cell activation and proliferation [258]. Approved for rheumatoid arthritis, the experience reveals stabilization of RA-ILD based on HRCT and FVC prospective evaluations [259][260][261][262][263][264][265]. Most of the impact was seen in carriers of the NSIP subtype [263], a finding that follows UIP in frequency in RA.…”