Op0037 non–anti-TNF Biologic Agents Are Associated With Less Marked Progression of Interstitial Lung Disease Secondary to Rheumatoid Arthritis

Abstract

Background:Objectives:To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) on the outcome of interstitial lung disease secondary to rheumatoid arthritis (ILD-RA).Methods:We performed a multicenter, prospective, observational study of patients with ILD-RA receiving DMARDs between 2015 and 2017. The patients were assessed using high-resolution computed tomography and lung function tests at baseline and at 24 months. The radiological assessment was centralized. The main outcome measure at 24 months was change in lung function (improvement, non-progression, progression, or death). We recorded the 28-joint Disease Activity Score 28 (DAS28) and adverse events. A logistic regression analysis was performed to identify factors associated with progression of ILD.Results:We included 70 patients with ILD-RA treated with DMARDs. The main baseline characteristics are shown in Table 1. After 24 months, lung disease did not progress in 40 patients (57.1%), improved in 8 (11.4%), and progressed in 21 (30.0%). One patient (1.4%) died. The factors associated with progression of ILD in the multivariate analysis were treatment with abatacept, tocilizumab, or rituximab (OR, 0.102 [95%CI, 0.015-0.686]), DAS28 (OR, 1.969 [95%CI, 1.005-3.857]), and smoking (OR, 6.937 [95%CI, 1.378-4.900]). During follow-up, 30 patients (42.9%) experienced an adverse event, which was severe in 12 cases (17.1%).Conclusion:Lung function is stable and inflammatory activity well controlled in most patients with ILD-RA receiving treatment with DMARDs. Non–anti-TNF DMARDs reduce the risk of progression of lung disease in 90% of patients, whereas the inflammatory activity of RA and smoking are associated with progression.Table:VariablePatients=70Epidemiological characteristicsFemale sex, n (%)39 (55.7)Age, y, mean (SD)68.8 (7.8)Clinical-laboratory characteristicsSmoking historyNever smoked, n (%)23 (32.9)Smoked, n (%)47 (67.1)Time since diagnosis of RA,(months),mean (SD)161.0 (125.9)Diagnostic delay,(months),median (IQR)12.0 (5.9-24.0)Time since diagnosis of ILD,(months),mean (SD)42.3 (48.3)Positive rheumatoid factor (>10), n (%)65 (92.0)Anticitrullinated protein antibody (>20), n (%)58 (82.9)Synthetic DMARDs64 (91.4)Methotrexate, n (%)30 (42.9)Leflunomide, n (%)16 (22.9)Sulfasalazine, n (%)8 (11.4)Hydroxychloroquine, n (%)10 (14.3)Biologic DMARDs27 (38.1)Infliximab, n (%)1 (1.4)Etanercept, n (%)4 (5.7)Adalimumab, n (%)1 (1.4)Golimumab, n (%)1 (1.4)Certolizumab, n (%)0 (0.0)Tocilizumab, n (%)5 (6.2)Abatacept, n (%)5 (6.2)Rituximab, n (%)10 (14.3)Other immunosuppressantsMycophenolate, n (%)4 (5.7)Azathioprine, n (%)1 (1.4)Disclosure of Interests:None declared