Predictive Value of Chest HRCT Patterns for Respiratory Adverse Event Among RA Patients Treated with Biological Therapy: Long-Term Results from an Observational Study

Takuya Matsumoto¹, Toshihisa Kojima¹, Nobunori Takahashi¹, Shuji Asai¹, Nobuyuki Asai¹, Tatsuo Watanabe², Tomonori Kobayakawa³, Naoki Ishiguro⁴, Shingo Iwano⁵ and Satoru Ito⁶, ¹Department of Orthopedic Surgery, Nagoya University Hospital, Nagoya, Japan, ²Nagoya University Hospital, Nagoya, Japan, ³Orthopeadic Sugery and Rheumatology, Nagoya University Hospital, Nagoya, Japan, ⁴Department of Orthopedic Suregery, Nagoya University Hospital, Nagoya, Japan, ⁵Department of Radiology, Nagoya University Hospital, Nagoya, Japan, ⁶Department of Respiratory Medicine, Nagoya University Hospital, Nagoya, Japan

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Lung Disease and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster III: Treatment – Monitoring, Outcomes, Adverse Events

Session Type: ACR Poster Session C

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

Background/Purpose: Biological therapy brought an important advance in the treatment strategy for rheumatoid arthritis (RA). However, the safety of biological therapy on RA patients with respiratory involvement such as interstitial lung disease (ILD) and airway disease (AwD) is still controversial. The aim of this study was to assess the association between risk for respiratory adverse events (RAE) and chest High-resolution computed tomography (HRCT) patterns and to detect predictors for RAE among RA patients receiving biological therapy.

Methods: We conducted a retrospective observational study including 235 patients with RA who received biological therapy in the seven years period of 2004 to 2010. The patients were clinically followed up for at least 6 years. Chest HRCT was performed in 214 patients at the induction of biological therapy. The obtained images were reviewed by two experienced thoracic radiologist independently. According to the detected ILD features (airspace-consolidation, ground-glass opacity (GGO), reticulation, honeycombing) and AwD features (bronchiectasis, bronchiolectasis, traction bronchiectasis, air trapping), we grouped the patients to ILD group (n=63), AwD group (n=30), and no abnormality group (n=121). We investigated the manifestations of respiratory infection, onset or worsening of ILD, and other respiratory events which required withdrawal of biological therapy as incidence of RAE. Cox regression models estimated the risk for incidence of RAE in each group and explored predictors for RAE incidence based on HRCT patterns and baseline characteristics.

Results: The mean age was 57.2 (range 20-84), 86.0% of patients were female, and mean (standard deviation) follow-up was 7.7 (1.3) years. Methotrexate was used in 77.1%, and oral corticosteroids in 37.9% at baseline. HRCT abnormalities were found in 35.8% of the all patients. ILD features were found in 27.8%, AwD in 9.7%. We identified 27 RAE episodes including bacterial pneumonia (10), acute onset or exacerbation of interstitial pneumonia (7), pneumocystis pneumonia: PCP (2), bronchitis (2), organized pneumonia (2), NTM (1), empyema (1), mycotic pneumonia (1), pleuritic (1). The incident rate of RAE was 15.7 cases per 1000 patient-years in all patients, 20.1 in IDL group, 49.5 in AwD group, and 8.75 in no abnormality group. Cumulative incident rate was higher in AwD group than ILD group (figure1). AwD (HR=6.27, 95%CI=2.83-13.9), old age (HR=4.23, 95%CI=2.07-9.41), level of anti-citrullinated peptide antibodies (ACPA) titer (HR=3.19, 95%CI=1.44-7.04) were associated with increased risk for RAE. However, ILD (HR=1.64, 95%CI=0.73-3.67) did not associated with the risk for RAE.

Conclusion: Pre-existence of AwD at induction of biological therapy was associated with higher risk for RAE than pre-existence of ILD. We identified Age, ACPA titer, and pre-existence of AwD as the predictors for RAE.

Disclosure: T. Matsumoto, None; T. Kojima, None; N. Takahashi, None; S. Asai, Takeda Pharma Co., 8,Janssen Pharmaceutica Product, L.P., 8,Astellas Pharma Co., 8,Tanabe Mitsubishi Pharma Co., 8,Eisai, 8,Bristol-Myers Squibb, 8,Chugai, 8,Pfizer Inc, 8,Abbvie Japan, 8,UCB Japan, 8; N. Asai, None; T. Watanabe, None; T. Kobayakawa, None; N. Ishiguro, Takeda, Mitsubishi-Tanabe, Astellas, Chugai, Abbott, Bristol-Myers Squibb, Eisai, Janssen, Kaken, Pfizer, 2,Takeda, Mitsubishi-Tanabe, Astellas, Chugai, Abbott, Bristol-Myers Squibb, Eisai, Janssen, Kaken, Pfizer, Taisho-Toyama, Otsuka, 8; S. Iwano, None; S. Ito, None.

To cite this abstract in AMA style:

Matsumoto T, Kojima T, Takahashi N, Asai S, Asai N, Watanabe T, Kobayakawa T, Ishiguro N, Iwano S, Ito S. Predictive Value of Chest HRCT Patterns for Respiratory Adverse Event Among RA Patients Treated with Biological Therapy: Long-Term Results from an Observational Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/predictive-value-of-chest-hrct-patterns-for-respiratory-adverse-event-among-ra-patients-treated-with-biological-therapy-long-term-results-from-an-observational-study/. Accessed .

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