JAK Inhibitors in Rheumatoid Arthritis-Interstitial Lung Disease. National Multicenter Study of 73 Patients, 55 of Baricitinib

Ana Serrano-Combarro¹, Belén Atienza-Mateo², Jesus Alejandro Valero-Jaimes³, Marta Pastor-Mena⁴, Rafael Benito Melero-Gonzalez⁵, David Castro-Corredor⁶, Maria Martin-Lopez⁷, Santos Castañeda⁸, Jesus Loarce-Martos⁹, Natalia Mena Vazquez¹⁰, Carmen carrasco-Cubero¹¹, Carolina Diez-Morrondo¹², andrea Garcia-Valle¹³, Gema Bonilla¹⁴, Juan Maria Blanco-Madrigal¹⁵, Natividad del Val del Amo¹⁶, Nuria Vegas Revenga¹⁷, Lorena Perez-Albadalejo¹⁸, Rafaela Ortega Castro¹⁹, Deseada Palma-Sanchez²⁰, Ana Maria fernandez-Ortiz²¹, Patricia Lopez-Viejo²², Maria Lopez-Lasanta²³, Marta Garijo Bufort²⁴, Ivette Casafont-Sole²⁵, Olga Maiz-Alonso²⁶, Juan Moreno-Morales²⁷, Ana Urruticoechea²⁸, Carolina Perez-Garcia²⁹, Jose Rosas³⁰, Virginia Ruiz-Esquide³¹, Delia Fernández-Lozano³², Ignacio Brana Abascal³³, Evelin Cecilia Cervantes-Perez³⁴, Julia Fernandez-Melon³⁵, Cristina Fernandez³⁶, Bryan Josue Flores Robles³⁷, Diego Ferrer³⁸ and Ricardo Blanco³⁹, ¹Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain, ²Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ³Hospital Bidasoa, Irún, Spain, ⁴Hospital de Jerez de la Frontera, Cádiz, Spain, ⁵CHU Vigo, O Carballino, Spain, ⁶General University Hospital of Ciudad Real, Santa Cruz de Mudela (Ciudad Real), Spain, ⁷Hospital 12 de Octubre, Madrid, Spain, ⁸Hospital Universitario de la Princesa, Madrid, Spain, ⁹Ramón y Cajal University Hospital, Madrid, Spain, ¹⁰IBIMA, Málaga, Spain, ¹¹Department of Rheumatology, Hospital Universitario de Badajoz, Badajoz, Spain, ¹²Division of Rheumatology, Hospital de León, León, Spain, ¹³Division of Rheumatology, Complejo Asistencial Universitario de Palencia, Palencia, Spain, ¹⁴Department of Rheumatology, Hospital Clínico Universitario La Paz, Madrid, Spain, ¹⁵Division of Rheumatology, H. Universitario de Basurto, Bilbao, Spain, ¹⁶Complejo Hospitalario de Navarra, Pamplona, Spain, ¹⁷Hospital Galdakao- Usansolo, Galdakao, Spain, ¹⁸Division of Rheumatology, Hospital Universitario de Jaén, Jaén, Spain, ¹⁹Hospital Reina Sofía, Cordoba, Spain, ²⁰Hospital Rafael Mendez, Lorca, Spain, ²¹CHU Badajoz, Badajoz, Spain, ²²Division of Rheumatology, Hospital Severo Ochoa, Leganéz, Spain, ²³Hospital Universitari Vall d'Hebron, Rheumatology, Barcelona, Spain, ²⁴H. de Sagunto, Valencia, Italy, ²⁵Hospital Universitari Germans Trias i Pujol, Badalona, Spain, ²⁶University Hospital Donostia, San Sebastian, Spain, ²⁷Hospital Universitario Santa Lucia Cartagena, Cartagena, Spain, ²⁸Hospital Can Misses, Ibiza, Spain, ²⁹Hospital del Mar, Barcelona, Spain, ³⁰Hospital Marina Baixa, Alicante, Spain, ³¹Hospital Clinic, Rheumatology, Barcelona, Spain, ³²Hospital de Mérida, Merida, Spain, ³³Division of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain, ³⁴Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain, ³⁵Division of Rheumatology, Hospital Universitario Son Espases, Palma de Mallorca, Spain, ³⁶Hospital Universitario San Juan de Alicante, Alicante, Spain, ³⁷Hospital Universitario San Pedro, Logroño, Spain, ³⁸Division of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ³⁹Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Meeting: ACR Convergence 2023

Keywords: autoimmune diseases, Disease-Modifying Antirheumatic Drugs (Dmards), interstitial lung disease, prognostic factors, rheumatoid arthritis

Session Information

Date: Tuesday, November 14, 2023

Title: (2141–2176) RA – Treatments Poster III

Session Type: 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). Abatacept and Rituximab are the recommended drugs. JAK inhibitors (JAKi) have demonstrated efficacy in RA. However, in clinical trials patients with active ILD were usually excluded. Moreover, a warning on ILD toxicity is included in SmPC (Summary of Product Characteristics) with tofacitinib (TOFA). Nonetheless, evidence on efficacy of JAKi in RA-ILD is growing. The objective of the study was to assess a) the effectiveness and b) the safety of JAKi in AR-ILD patients.

Methods: National multicenter study of 73 RA-ILD patients on treatment with JAKi. We analyzed from baseline the following outcomes: a) forced vital capacity (FVC), b) diffusing capacity of the lungs for carbon monoxide (DLCO), c) chest high resolution computed tomography (HRCT), d)dyspnea (modified Medical Research Council scale), e) arthritis activity (DAS28-ESR or clinical records), and f) sparing corticosteroids effect.

Results: We studied 73 patients (50 women/ 23 men; mean age 66 ± 10 years) from clinical practice on treatment with JAKi [Baricitinib (BARI)= 55 (74%), TOFA= 8 (11%), Upadacitinib (UPA)= 8 (11%), Filgotinib (FILGO)= 2 (3%)]. Baseline demographic and clinical characteristics are shown in Table 1. All patients had received disease-modifying antirheumatic drugs (DMARDs) before JAKi [Methotrexate (63; 86%), Leflunomide (46; 63%), Sulfasalazine (19; 26%), Hydroxychloroquine (16; 22%), Abatacept (47; 64%), Tocilizumab (26; 36%) and Rituximab (16; 22%)]. Since most patients were on BARI we focused on this group (n=55). Median [IQR] ILD duration up to BARI initiation was of 29 [15-64] months. Mean baseline values of FVC and DLCO (% predicted) were 88±27 and 69±20, respectively. Patients were followed-up for a mean of 36 ± 23 months. The evolution of FVC and DLCO remained stable during the first 12 months (Figure 1). At the end of the follow-up, available chest HRCT images improved/ stabilized in 76% of patients. Stabilization or improvement of dyspnea was found in 95% of patients. Most patients showed articular remission or low activity. BARI was withdrawn in 22 (42%) patients due to articular inefficacy (n=15), lung inefficacy (n=4), development of hypersensitivity pneumonitis (n=1), and appearance of brain cancer (n=1).

Conclusion: JAKi, especially BARI, may be useful and safe in controlling the course of both pulmonary and joint disease in RA-ILD patients, even in refractory cases.

Table 1. Baseline characteristics of RA-ILD patients treated with JAKi.

Figure 1. Evolution of pulmonary function tests (mean % of the predicted FVC and DLCO) in RA-ILD patients with BARI therapy at baseline and 24 months.

Disclosures: A. Serrano-Combarro: None; B. Atienza-Mateo: None; J. Valero-Jaimes: None; M. Pastor-Mena: None; R. Melero-Gonzalez: None; D. Castro-Corredor: None; M. Martin-Lopez: None; S. Castañeda: None; J. Loarce-Martos: Boehringer-Ingelheim, 6, Bristol-Myers Squibb(BMS), 6, Galapagos, 6; N. Mena Vazquez: None; C. carrasco-Cubero: None; C. Diez-Morrondo: None; a. Garcia-Valle: None; G. Bonilla: None; J. Blanco-Madrigal: None; N. del Val del Amo: None; N. Vegas Revenga: None; L. Perez-Albadalejo: None; R. Ortega Castro: None; D. Palma-Sanchez: None; A. fernandez-Ortiz: None; P. Lopez-Viejo: None; M. Lopez-Lasanta: None; M. Garijo Bufort: None; I. Casafont-Sole: None; O. Maiz-Alonso: None; J. Moreno-Morales: None; A. Urruticoechea: None; C. Perez-Garcia: None; J. Rosas: None; V. Ruiz-Esquide: None; D. Fernández-Lozano: None; I. Brana Abascal: None; E. Cervantes-Perez: None; J. Fernandez-Melon: None; C. Fernandez: None; B. Flores Robles: None; D. Ferrer: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6.

To cite this abstract in AMA style:

Serrano-Combarro A, Atienza-Mateo B, Valero-Jaimes J, Pastor-Mena M, Melero-Gonzalez R, Castro-Corredor D, Martin-Lopez M, Castañeda S, Loarce-Martos J, Mena Vazquez N, carrasco-Cubero C, Diez-Morrondo C, Garcia-Valle a, Bonilla G, Blanco-Madrigal J, del Val del Amo N, Vegas Revenga N, Perez-Albadalejo L, Ortega Castro R, Palma-Sanchez D, fernandez-Ortiz A, Lopez-Viejo P, Lopez-Lasanta M, Garijo Bufort M, Casafont-Sole I, Maiz-Alonso O, Moreno-Morales J, Urruticoechea A, Perez-Garcia C, Rosas J, Ruiz-Esquide V, Fernández-Lozano D, Brana Abascal I, Cervantes-Perez E, Fernandez-Melon J, Fernandez C, Flores Robles B, Ferrer D, Blanco R. JAK Inhibitors in Rheumatoid Arthritis-Interstitial Lung Disease. National Multicenter Study of 73 Patients, 55 of Baricitinib [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/jak-inhibitors-in-rheumatoid-arthritis-interstitial-lung-disease-national-multicenter-study-of-73-patients-55-of-baricitinib/. Accessed .

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