Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients,☆☆

https://doi.org/10.1016/j.semarthrit.2017.12.012Get rights and content

Abstract

Objective

Interstitial lung disease (ILD) is one of the most serious complications of rheumatoid arthritis (RA). In the present study, we aimed to assess the efficacy of abatacept (ABA) in patients with ILD associated to RA.

Methods

National multicenter, non-controlled, open-label registry study of RA patients with ILD treated with ABA.

Results

63 patients (36 women) with RA-associated ILD undergoing ABA therapy were studied. The mean ± standard deviation age at the time of the study was 63.2 ± 9.8 years. The median duration of RA and ILD from diagnosis were 6.8 and 1 year, respectively. RA was seropositive in 55 patients (87.3%). In 15 (23.8%) of 63 patients the development of ILD was closely related to the administration of synthetic or biologic disease modifying anti-rheumatic drugs. After a follow-up of 9.4 ± 3.2 months, two-thirds of patients remained stable whereas one-quarter experienced improvement in the Modified Medical Research Council scale. At that time forced vital capacity remained stable in almost two-thirds of patents and improved in one out of five patients assessed. Also, diffusing capacity of the lung for carbon monoxide remained stable in almost two-thirds and showed improvement in a quarter of the patients assessed. At 12 months, 50% of the 22 patients in whom chest HRCT scan was performed due persistence of respiratory symptoms showed stabilization, 8 (36.4%) improvement and 3 worsening of the HRCT scan pattern. Eleven of 63 patients had to discontinue ABA, mainly due to adverse events.

Conclusion

ABA appears to be an effective in RA-associated ILD.

Section snippets

Design, enrollment criteria and definitions

A national multicenter, noncontrolled, open-label registry study of patients with ILD associated to RA treated with ABA was conducted. Patients with ILD attending the Rheumatology divisions of 31 centers from Spain between 2000 and 2016 who had at least a 3-month follow-up period after starting ABA were assessed. Data were retrieved from the clinical records and stored in a computerized database.

RA was diagnosed according to the ACR 1987 classification criteria [21] or the ACR/EULAR 2010

Baseline clinical characteristics at abatacept onset

We studied 63 patients (36 women/27 men) with RA-associated ILD treated with ABA.

Baseline features of the series before ABA onset are summarized in the Table. The mean age at ABA onset was 63.2 ± 9.8 years. At that time, the duration of RA and ILD from diagnosis were 6.8 (IQR 2–13.6) and 1 (IQR 0.3–3.3) years, respectively. Patients were positive for RF or CCPA in 55 (87.3%) and 54 (85.7%) of the 63 cases, respectively. In addition to the use of HRCT for the diagnosis of ILD, histological

Discussion

We studied 63 patients with RA-associated ILD treated with ABA. We assessed the following data: dyspnea, lung function tests (FVC and DLCO) and HRCT findings. Most patients yielded stabilization or improvement of these variables.

The pathogenesis of RA-associated ILD remains unknown. There are several predisposing factors such as male gender, older age, and cigarette smoking, that are also predictors of mortality [27], [28]. Indeed, cigarette smoking may represent an upstream trigger leading to

Acknowledgments

To the members of the participating hospitals.

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    Disclaimers: The views expressed in the submitted article are the authors own. No funding from any pharmaceutical company was received for preparation of this manuscript.

    ☆☆

    This work was partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from ‘‘Instituto de Salud Carlos III’’ (ISCIII), Spain.

    1

    Dr. Carlos Fernández Díaz and Dr. Javier Loricera shared first authorship.

    2

    Dr. José L. Hernandez, Prof. Miguel A. González-Gay and Dr. Ricardo Blanco shared senior authorship in this study.

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