Session Information
Date: Sunday, November 8, 2015
Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Interstitial lung disease (ILD) associated with RA is a big concern particularly in Japanese patients evidenced by the reports that the cause of death in approximately 10 % of patients with RA is ILD. We have reported that ILD exacerbated in 24 % (14/58) of RA patients associated with ILD when TNF-inhibitors were administrated and 2 of 14 died of ILD, although the degree of exacerbation was minimal in half of the patients (Nakashita T, et al. BMJ open 2014). We extended this study, namely, we added the number of patients, elongated the observation periods and tried to extract the risk factors for the exacerbation of ILD after administration of bDMARDS.
Methods:
Subjects were 93 patients with RA (male/female = 40/53, mean age 63) associated with ILD who were administrated with various bDMARDS. Chest X-ray film (CXR) was taken at least every 3 months. Chest CT scan was done before and every yearly, and when newly developed shadows were found on CXR or when patients complained of respiratory symptoms for more than 2 weeks, chest CT scan was done. The severity of ILD was graded into 4, grade 0 to grade 3, according to the extent of ILD on chest CT by the method of Gochuico et al. (Arch Intern Med 2008). Chest CT images were graded by 2 independent respirologists. The patterns of ILD were also evaluated by 2 respirologists. Risk factors for the exacerbation of ILD were extracted by discriminant analysis.
Results:
The mean observation period was 23.9 months (range 2 – 90 months). MTX and prednisolone (PSL) were under use at the introduction of bDMARD in 61 % (mean 7.6 mg/week) and in 85 % (mean 7.2 mg/day), respectively. The administrated bDMARDS were as follows; abatacept (ABT) in 23, adalumumab (ADA)in 2, certolizumab (CZP) in 3, etanercept (ETN) in 43, infliximab (IFX) in 10, and tocilizumab (TCZ) in 12, respectively. The ILD grades were 1 in 54 patients, 2 in 29, and 3 in 10, respectively. The ILD patterns evaluated by HRCT were NSIP in 72 patients, UIP in 8, and OP in 13, respectively. Exacerbation of ILD was recognized in 15 patients (16 %), with the mean administration period of 6.5 months (2 – 14 months). The bDMARDS at the time of ILD exacerbation ware ABT in 1, ADA in 1, ETN in 8, and IFX in 5, respectively. Discriminant analysis was done incorporating 19 variables such as kind of bDMARDS, age, gender, duration of bDMADS administration , ILD pattern, ILD grade, dose of MTX and PSL, KL-6 value, DAS28ESR, RF titer, and others, and only 1 significant risk factor (TNF-inhibitors) was extracted. Odds ratio of ILD exacerbation for TNF-inhibitors was 10.
Conclusion: We should be cautious for the exacerbation of ILD when TNF-inhibitors were administrated.
To cite this abstract in AMA style:
Nakashita T, Dibatake A, Matsumoto K, Hamada Y, Motojima S. Risk Factors for the Exacerbation of Interstitial Lung Disease (ILD) after Administration of Biologic Dmards in RA Patients with Pre-Existing ILD [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/risk-factors-for-the-exacerbation-of-interstitial-lung-disease-ild-after-administration-of-biologic-dmards-in-ra-patients-with-pre-existing-ild/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-the-exacerbation-of-interstitial-lung-disease-ild-after-administration-of-biologic-dmards-in-ra-patients-with-pre-existing-ild/