Efficacy of rituximab in slowing down progression of rheumatoid arthritis–related interstitial lung disease: data from the NEREA Registry

Abstract

Objectives To asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated. Methods A longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6–12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI. Results A total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI. Conclusion RA-ILD patients deteriorate over time, with the median time free of impairment being <2 years. Patients exposed to RTX had a higher probability of remaining free of FI compared with other therapies. Other factors have also been identified.

A retrospective comparison of respiratory events with JAK inhibitors or rituximab for rheumatoid arthritis in patients with pulmonary disease

“…This has led to hesitancy in utilizing these medications although systematic review of the evidence is beginning to allay fears [2,3]. Recently, data have begun to support the safe and effective use of B and T cell therapies, rituximab [4] and abatacept [5], in the management of rheumatoid arthritisrelated ILD and bronchiectasis [6,7]. However, therapeutic options remain limited.…”

Rituximab in the Treatment of Interstitial Lung Disease Associated with Autoimmune Diseases: Experience from a Single Referral Center and Literature Review

“…The results of these reports show, in general, an improvement in PFTs in IIM-ILD patients and a stabilization of lung affection in SSc-ILD patients treated with RTX. Experience with RTX in other AD with lung involvement is scarce [ 16 , 38 , 39 , 40 , 41 ]. Our series also included 2 MPO-ANCA-positive patients with pulmonary fibrosis but no other manifestations of systemic vasculitis.…”

Lung ultrasound in patients with rheumatoid arthritis and the definition of significant interstitial lung disease

“…The mean time between RA-ILD diagnosis and RA diagnosis is 4.9 years, and at RA-ILD diagnosis a significant reduction in DLco is already present, with oxygen-therapy needed in half of the subjects [17]. ILD is a frequent extra-articular involvement, which can deteriorate rather rapidly [18], and imposes a severe burden on affected patients. The therapeutic armamentarium for treating this condition is fortunately becoming richer, although to date there are no specific recommendations on how to treat RA-ILD [19].…”