Background/Purpose: Interstitial lung disease (ILD) is one of complication in patients with rheumatoid arthritis (RA) and its presence often has an effect on the management of RA. As the presence of ILD is thought to be one of risk factors of pulmonary infection, careful attention should be needed when biological products are used for the treatment of RA with ILD. Although the usefulness of biologics in RA patients without ILD has been already shown, the utility of biologics in patients with RA complicated with ILD remains unclear. Therefore, the aim of this study is to examine differences in the efficacy and safety of biologics for RA with ILD and without ILD.

Methods: Patients with RA who fulfilled the ACR 1987 or 2010 ACR/EULAR classcication criteria and were treated with Abatacept (ABT) at Tokai University Hospital between 2009 and 2018 were enrolled. We retrospectively collected clinical information from medical records and stored computerized database. We compared the efficacy and safety between RA patients with ILD and without ILD. Both disease activities and safety were evaluated using DAS28-CRP, CDAI, SDAI, occurrence of adverse events and continuation rate of ABT at 52 weeks. Statistical analyses were performed using paired T-test, Man-Whitney test, and the log-rank test.

Results: Twenty-eight patients with RA were enrolled. Among these patients, 2 patients were excluded because of lack of data. Of these 26 patients, 15 (58%) were complicated with ILD. There were no significant differences in age, gender, disease duration, positivity of rheumatoid factor or anti-citrullinated peptide antibodies, DAS28-CRP, CDAI and SDAI score at baseline of each group. However, RA with ILD group had significantly higher rate of combination use and the dosage of PSL than RA without ILD group at baseline. DAS28-CRP, CDAI and SDAI were significantly improved after treatment at 52 weeks in both group (RA with ILD group: 3.8 vs. 2.6, P< 0.05; 16.4 vs. 4.4, P< 0.001; 15.7 vs. 4.2, P< 0.001, RA without ILD group: 3.6 vs. 2.1, P=0.004; 18.1 vs. 6.5, P< 0.05; 16.6 vs. 6.2, P< 0.05, respectively). There were no significant differences in mean % change of DAS28-CRP, CDAI and SDAI at 52 weeks between both groups (-1.5 vs. -1.9, P=0.8, -12.0 vs. -11.6, P=0.8, -11.5 vs. -10.3, P=0.7, respectively). There was no significant difference in the continuation rate of ABT between two groups (93.3% vs. 100%, P=0.4).

Conclusion: These results suggested that ABT demonstrated the same efficacy and safety in patients with RA complicated with ILD as well as RA without ILD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-the-efficacy-and-safety-of-abatacept-in-rheumatoid-arthritis-patients-with-and-without-interstitial-lung-disease/