Background/Purpose : Interstitial lung disease (ILD) associated with RA is a big concern particularly in Japanese patients evidenced by the reports that the cause of death in approximately 10 % of patients with RA is ILD compared with only few percent in western countries.  We have reported that ILD exacerbated in 24 % (14/58) of RA patients associated with ILD when TNF-inhibitors were administrated and 2 of 14 died of ILD, although the degree of exacerbation was minimal in half of the patients (ACR 2012).  Here we retrospectively analyzed the effects of abatacept (ABT), a CTLA4-Ig fusion protein, on RA associated with ILD.

Methods: Subjects were 16 patients with RA (male/female = 6/10, mean age 71 years-old) associated with ILD who were administrated with ABT for longer than 52 weeks and analysis was done for the changes between 0 to 52 weeks, because the exacerbation of ILD developed between 4 to 52 weeks of administration of TNF-inhibitors with the mean of 24 weeks in our previous study.  Chest CT scan was done before and 52 weeks after administration of ABT.  Chest X-ray film (CXR) was taken at least every 3 months.  When newly developed shadows were found on CXR or when patients complained of respiratory symptoms for more than 2 weeks, chest CT scan was done.  The severity of ILD was graded into 4, grades 0 to grade 3, according to the extent of ILD on chest CT by the method of Gochuico et al. (Arch Intern Med 2008).  Chest CT images were graded by 2 independent respirologists.

Results :All the patients completed 52 weeks administration and no-one abandoned ABT due to the exacerbation of ILD.  The grades of ILD (grade 0/1/2/3) before and at 52 weeks were 0/9/4/3 and 2/7/4/3, respectively.  In 2 patients with grade 1, the grade decreased to 0, suggesting the improvement of ILD.  We further attempted to analyze more in detail the CT images according to the method by Kondoh et al. (Respirology 2013), and obtained what % of lung fields have findings of ILD .  All the abnormalities suggestive of ILD before and at 52 weeks were 12.9 +/- 12.7 (mean +/- SD) and 12.2 +/- 13.9, respectively, and no significant differences were found.  Mean DAS28-ESR and SDAI decreased from 4.47 +/- 1.44 to 2.84 +/- 0.85, and from 16.9 +/- 11.7 to 8.1 +/- 4.2, respectively, and the differences were statistically significant.   The mean dose of PSL decreased from 6.6 mg/day to 5.6 mg/day significantly (n = 15).  KL-6, a biomarker of ILD, did not change significantly.

Conclusion : ABT can be used safely for RA patients with ILD.  ABT even may improve ILD and is an appropriate treatment option for such patients.

Authors do not have any COI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/abatacept-can-be-used-safely-for-ra-patients-with-interstitial-lung-disease/