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 BARI was withdrawn in 22 (42%) patients due to articular inefficacy (n=15), lung inefficacy (n=4), development of hypersensitivity pneumonitis (n=1), and appearance of brain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.
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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ACR Meeting Abstracts - https://acrabstracts.org/abstract/jak-inhibitors-in-rheumatoid-arthritis-interstitial-lung-disease-national-multicenter-study-of-73-patients-55-of-baricitinib/