ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2583

Abatacept in Rheumatoid Arthritis with Interstitial Lung Disease: A Multicenter Study of  55  Patients

Carlos Fernández-Díaz1, Javier Loricera1, Santos Castañeda2, Clara Ojeda-Garcia3, Alejandro Olivé4, Patricia E. Carreira5, Trinidad Perez Sandoval6, Miriam Retuerto7, Evelin Cecilia Cervantes Pérez8, Samantha Rodriguez-Muguruza4, Bryan Josue Robles Flores9, Blanca Hernández-Cruz10, Ana Urruticoechea11, O. Maiz Alonso12, Desiree Palma13, Luis Arboleya14, Gema Bonilla15, Íñigo Hernández-Rodríguez16, Concepción Delgado17, Rosa Expósito Molinero18, Ana Ruibal Escribano19, Juan Blanco Madrigal20, José Antonio Bernal21, Manuel Rodríguez-Gómez22, Paloma Vela Casasempere23, Belen Alvarez-Rodriguez24, María Concepción Fito Manteca25, Francisco Ortiz Sanjuan26, Javier Narváez27, Manuel Jose Moreno28, Mireia Lopez-corbeto29, Natalia Mena-Vazquez30, Lucia C. Domínguez-Casas1, Clara Aguilera-Cros31, Victor Mora-Cuesta32, Natalia Palmou-Fontana1, Miguel Angel Gonzalez-Gay33, José Luis Hernandez34 and Ricardo Blanco1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 2Rheumatology, Hospital de la Princesa, IIS-IP, Madrid, Spain, 3Rheumatology, Hospital Virgen de la Macarena, Sevilla, Spain, 4Rheumatology, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, 5Multidisciplinary Pulmonary Hypertension Unit. Hospital Universitario 12 de Octubre, Madrid, Spain, 6Rheumatology, Hospital de León, LEÓN, Spain, 7Rheumatology, Hospital de Leon, Leon, Spain, 8Rheumatology, Hospital Santiago de Compostela, Santiago de Compostela, Spain, 9Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, 10Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain, 11Hospital Can Misses, Ibiza, Spain, 12Rheumatology, Hospital Donostia, San Sebastian, Spain, 13Rheumatology, Rafael Mendez Hospital, Spain., Lorca (Murcia), Spain, 14Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain, 15Rheumatology, Hospital La Paz - IdiPaz, Madrid, Spain, 16Rheumatology, CHUVI Vigo, Vigo, Spain, 17Rheumatology, Hospital Clinico Universitario Lozano Blesa, zaragoza, Spain, 18Rheumatology, Hospital Comarcal de Laredo. Spain, Laredo, Spain, 19Rheumatology, Hospital Universitario de Araba, Vittoria, Spain, 20Rheumatology, Hospital de Basurto, BIlbao, Spain, 21Sección de Reumatología, Hospital General de Alicante, Alicante, Spain, 22Complejo Hospitalario Universitario de Ourense, Ourense, Spain, 23Rheumatology, Hospital General de Alicante, Alicante, Spain, 24Hospital Txagorritxu, Vittoria, Spain, 25Reumatología, Hospital de Navarra, Pamplona, Spain, 26Rheumatology, Hospital La Fe, Valencia, Spain, 27Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain, 28Rheumatology, Hospital Virgen de la Arrixaca, MURCIA, Spain, 29Hospital Universitario Vall d'Hebron, Barcelona, Spain, 30Rheumatology, Hospital Universitario de Malaga, Malaga, Spain, 31Rheumatology, Hospital Virgen del Rocio, Sevilla, Spain, 32Neumology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 33Department of RheumaRheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 34Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , , ,

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy - Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Interstitial Lung Disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). A potential association of anti-TNFα drugs and conventional disease-modifying anti-rheumatic drugs (cDMARDs), such as methotrexate (MTX) and leflunomide (LFN), with the development of ILD in patients with RA has been suggested. The aim of our study was to assess the efficacy and safety of abatacept (ABA) in RA patients with ILD.

Methods:   Multicenter study of RA patients with ILD treated with ABA. ILD was diagnosed by high-resolution computed tomography (HRCT). ABA was used at standard dose (10 mg/Kg/4 weeks i.v. or 125 mg/week s.c.). To assess the efficacy of ABA, we have analyzed the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) FVC improvement > 10%; and improvement > 10% in DLCO; c) radiological improvement in HRCT scan, and d)changes in the joint assessment measured by DAS28 score. Values were compared with baseline. Continuous variables by means of Wilcoxon´s signed rank test, and percentages by using the Chi-squared test or Fisher´s exact test as appropriate.

Results:   We studied 55 patients (30 women/25 men) with ILD associated to RA; mean age 62.7±9.05 years. The median [IQR, 25th-75th] duration of RA to ILD diagnosis was 7 [2.33-14.00] years. Patients had received a mean of 2.36±1.9 DMARDs. RA was seropositive in 46 cases (83.6%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 10 patients. ILD was considered as drug-related in 14 patients: MTX (n=7), etanercept (n=3), adalimumab (n=3) and certolizumab (n=1). ABA was prescribed as monotherapy (n=28) or combined with cDMARDs (n=27); these were LFN (n=7), LFN and cyclosporine (n=1), sulfasalazine (n=2), MTX (n=3), MTX and LFN (n=1), hydroxychloroquine (n=6), hydroxychloroquine and LFN (n=4), and azathioprine (n=3). The results are summarized in Table. A significant improvement of the dyspnea was observed. The patients who did not have dyspnea at ABA onset remained asymptomatic during the follow-up. FVC and HRCT showed a significant improvement between 6 and 12 months after the onset of therapy. DLCO remained stable in the majority of the patients. DAS28 also improved. After a follow-up of 8.29±3.82 months, the most important adverse effects were: respiratory infection (n=2), urinary infection (n=1) and infusion reaction (n=1). ABA had to be withdrawn in 7 patients: due to severe infection (n=2); inefficacy in polyarthritis (n=2), lack of pulmonary improvement (n=2) and infusion reaction (n=1).

Conclusion:   ABA appears to be an effective and relatively safe therapy in RA patients with ILD. These promising results require to be confirmed in a prospective and randomized study. TABLE

Baseline

3 months

6 months

12 months

MMRC, – No change – Improvement – Worsening

–

–

–

81.8%

16.4%**

1.81%

72.2%

25%**

2.7%

62.9%

29.6%**

7.5%

FVC, – No change – Improvement – Worsening

–

–

–

84.6%

7.7%

7.7%

53.3%

26.7%**

2.0%

61.2%

27.7%*

11.1%

DLCO, – No change – Improvement – Worsening

–

–

–

58.4%

33.3%**

8.3%

58.3%

16.7%

25.0%

57.1%

28.6%**

14.3%

HRCT scan, – No change – Improvement – Worsening

–

–

–

66.7%

33.3%*

0.0%

38.4%

46.2%**

15.4%

35.7%

42.9%**

21.4%

DAS28, median [IQR]

5.25 [4.13-5.85]

2.61 [2.14-4.04]**

3.10 [2.20-4.18]**

3.55 [2.30-4.40]**

CRP (mg/dl), median [IQR]

2.28 [1.08-6.95]

1.70 [0.64-5.00]

0.87 [0.50-5.40]**

2.16 [1.43-7.69]

ESR (mm/1st h), median [IQR]

33.0 [16.8-51.8]

20.0 [10.0-44.0]**

22.0 [9.0-38.0]*

30.0 [12.5-53.0]**

Comparisons refer to baseline values. * p< 0.05; **p< 0.01.  In the case of qualitative variables only “improvement” was considered in the calculations.

Disclosure: C. Fernández-Díaz, None; J. Loricera, None; S. Castañeda, None; C. Ojeda-Garcia, None; A. Olivé, None; P. E. Carreira, None; T. Perez Sandoval, None; M. Retuerto, None; E. C. Cervantes Pérez, None; S. Rodriguez-Muguruza, None; B. J. Robles Flores, None; B. Hernández-Cruz, None; A. Urruticoechea, None; O. Maiz Alonso, None; D. Palma, None; L. Arboleya, None; G. Bonilla, None; Í. Hernández-Rodríguez, None; C. Delgado, None; R. Expósito Molinero, None; A. Ruibal Escribano, None; J. Blanco Madrigal, None; J. A. Bernal, None; M. Rodríguez-Gómez, None; P. Vela Casasempere, None; B. Alvarez-Rodriguez, None; M. C. Fito Manteca, None; F. Ortiz Sanjuan, None; J. Narváez, None; M. J. Moreno, None; M. Lopez-corbeto, None; N. Mena-Vazquez, None; L. C. Domínguez-Casas, None; C. Aguilera-Cros, None; V. Mora-Cuesta, None; N. Palmou-Fontana, None; M. A. Gonzalez-Gay, None; J. L. Hernandez, None; R. Blanco, None.

To cite this abstract in AMA style:

Fernández-Díaz C, Loricera J, Castañeda S, Ojeda-Garcia C, Olivé A, Carreira PE, Perez Sandoval T, Retuerto M, Cervantes Pérez EC, Rodriguez-Muguruza S, Robles Flores BJ, Hernández-Cruz B, Urruticoechea A, Maiz Alonso O, Palma D, Arboleya L, Bonilla G, Hernández-Rodríguez Í, Delgado C, Expósito Molinero R, Ruibal Escribano A, Blanco Madrigal J, Bernal JA, Rodríguez-Gómez M, Vela Casasempere P, Alvarez-Rodriguez B, Fito Manteca MC, Ortiz Sanjuan F, Narváez J, Moreno MJ, Lopez-corbeto M, Mena-Vazquez N, Domínguez-Casas LC, Aguilera-Cros C, Mora-Cuesta V, Palmou-Fontana N, Gonzalez-Gay MA, Hernandez JL, Blanco R. Abatacept in Rheumatoid Arthritis with Interstitial Lung Disease: A Multicenter Study of  55  Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/abatacept-in-rheumatoid-arthritis-with-interstitial-lung-disease-a-multicenter-study-of-55-patients/. Accessed .

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/abatacept-in-rheumatoid-arthritis-with-interstitial-lung-disease-a-multicenter-study-of-55-patients/