THU0186 Rheumatoid arthritis and interstitial lung disease. multicentric retrospective study of 118 patients treated with biological no anti tnf

Abstract

Background: Interstitial lung disease (ILD) associated with Rheumatoid Arthritis (RA) has a poor prognosis. Treatments such as anti-TNF, have been implicated in the exacerbation of an ILD. Objectives: Our objective is to evaluate and compare the evolution of ILD in patients with RA treated with Abatacept (ABA), Rituximab (RTX) and Tocilizumab (TCZ) after 1 year of treatment. Methods: Retrospective multicentre study of patients with ILD and AR treated with ABA, RTX and TCZ at standard doses. The ILD was diagnosed by CT. Conclusions: There seems to be a trend towards a better radiological response in patients treated with RTX and ABA. It would be necessary prospective studies. Background: Approximately a third of Rheumatoid Arthritis (RA) patients treated with tumour necrosis factor (TNF)-a inhibitors such as Infliximab (IFX) fail to respond. This has prompted a widespread interest in the finding of measures for predictors of response to TNFa inhibitors. Objectives: To search for serum autoantibodies that aid to identify RA patients most likely to benefit from IFX. Methods: We analysed serum of 170 biologic-naïve RA patients at baseline assigned to receive IFX plus methotrexate. The serum samples were distributed in 3 independent samples sets that were provided by 3 different sources: 1 discovery sample set (n=24) collected from Hospital Clínico Universitario of Santiago de Compostela (Spain) and 2 validation sample sets collected from Hospital Universitario de A Coruña (Spain), (n=61); and the Swedish Farmacotherapy (SWEFOT) trial (Sweden), (n=85). The European League Against Rheumatism (EULAR) criteria were used to assess the clinical response at six months of follow-up: good response (GR, n=60), moderate (MR, n=60) and non-response (NR, n=50). A suspension bead array platform built on protein fragments within Human Protein Atlas and selected from an initial screening using an array containing 42 000 antigens was employed to identify the IgG and IgA autoantibodies in the discovery sample set and validate the results within the 2 validation sets. Thresholds for autoantibodies were calculated by Receiver Operating Characteristics (ROC) curve analysis performed with SPSS 24. Results: Our data revealed a more prevalent IgG reactivity and higher IgG autoantibody levels against the antigen Centromere Protein F (CENPF) in GR when compared with NR, showing an overall reactivity of 31% vs 0%, 45% vs. 26% and 17% vs 4% in the three sample sets analysed respectively. The area under the ROC curve was 0,649 [p-value=0.049; IC 95% (0.510-0.789)]. CENP-F is a proliferation-associated and cell cycle-dependent centromere autoantigen that might be involved in the increased or abnormal cell proliferation that occurs during RA process. Interestingly, our results also showed that IgA autoantibodies levels toward the antigen Solute Carrier family 39 member 2 (SLC39A2), a zinc transporter protein, were decreased in GR when compared with MR in the discovery sample set and this trend was significantly validated (p=0.018) in the SWEFOT c...

Rheumatoid arthritis-associated interstitial lung disease: epidemiology, risk/prognostic factors, and treatment landscape

“…Dyspnea outcomes were reported in seven studies investigating ABA (k=4) (33)(34)(35)45), RTX (k=3) (38,39,45), and TOC (k=2) (42,45), all of which used the MMRC scale (Suppl. Timepoints for prevalence estimates have been converted to months for ease of comparison.…”

“…tions, RTX (k=6) (37-40, 45, 48) and ABA (k=4) (33)(34)(35)45) were the most common therapeutic agents. Absolute and percent change in FVC were each reported by one study, both evaluating RTX treatment regimens (37,40).…”

Interstitielle Lungenbeteiligung bei der rheumatoiden Arthritis

“…Abatacept wurde v. a. durch eine spanische Arbeitsgruppe um Fernandez-Diaz et al untersucht, welche zunächst an 63 Patienten zeigte, dass Abatacept in einem Großteil der eingeschlossenen Patienten die ILD stabilisierte und in einem geringen Teil auch zu einer Verbesserung führte 34 . 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 .…”