Session Information
Date: Tuesday, November 7, 2017
Title: Rheumatoid Arthritis – Clinical Aspects Poster III: Comorbidities
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Anti-TNFα drugs and several conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (MTX) have been involved in the development of Interstitial Lung Disease (ILD).
Our aim was to assess the efficacy and safety of Rituximab (RTX) in RA patients with ILD.
Methods: Retrospective multicenter study of RA patients with ILD treated with RTX. ILD was diagnosed by high-resolution computed tomography (HRCT). RTX was used at standard dose (1 gx2 and premedication with 100mg iv Methylprednisolone for a six month interval. We assess the the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) Forced vital capacity (FVC) improvement ≥10%; and improvement ≥10% in DLCO; c) radiological changes in HRCT scan, and d) changes in the joint assessment measured by DAS28 score.
Results: We studied 32 patients (23 women /9 men) with ILD associated to RA. The mean age±SD was 63.7±10.1 years. The median [IQR] to progression of ILD previusly RTX was 18 [6-43] months. They had received the following DMARDs previously; MTX (n=16), Leflunomide (LFN) (n=16) mycophenolate (MMF) (n=1) sulfasalazine (SSZ) (n=8), hydroxichloroquine (HCQ) (n=7), azathioprine (AZA) (n=3), gold salts (n=2), D-penicillamine (n=1), cyclophosphamide (n=2). 14 patients had previously received biological drugs. Cyclic citrullinated peptide antibodies (CCPA) were postive in 29 cases (94%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 12 patients. In 3 patients ILD was drug-related: MTX (n=3). RTX was prescribed as monotherapy (n=12) and combined with DMARDs (n=19). The DMARDs prescribed were: LFN (6), SSZ (2), MTX (7), HCQ (3), AZA (3) MMF (1). A significant improvement of the dyspnea was observed. FVC and HRCT showed an improvement in the period between 6 and 12 months. DLCO remained stable in the majority of the patients. DAS28 also improved
TABLE
|
Baseline |
3 months |
6 months |
12 months |
|
|
MMRC, n (%) – No change – Improvement – Worsening |
22 14 (67) 8 (33) 0 |
24 14(63) 10 (37) 0 |
25 15 (63) 9 (37) 1 |
|
|
FVC, n (%) – No change – Improvement – Worsening |
10 14 (70) 2 (10) 2 (20) |
12 1 (100) 10 1 |
22 16 (77) 5(23) 1 |
|
|
DLCO, n (%) – No change – Improvement – Worsening |
9 8 (83) 0 1 (17) |
14 10 (33) 2 (67) 2 |
20 15 (66) 3 (17) 2 (17) |
|
|
HRCT, n (%) – No change – Improvement – Worsening |
8 7 (86) 1 (14) 0 |
13 9 (76) 1 (8) 2 (16) |
14 9 (64) 4 (39) 1 (7) |
|
|
DAS28 CRP, -Mean |
4.88±1.44 |
3.70± 1.19 |
3.61±0.98 |
2.89±0.93 |
Conclusion: RTX seems to be an effective and relatively safe treatment in RA patients with ILD. However, these data should be verified in prospective and randomized studies.
To cite this abstract in AMA style:
Fernández-Díaz C, Reina D, Rubio-Muñoz P, Urruticoechea-Arana A, Carrasco-cubero M, Martín-López M, Miranda-Filloy JA, Villa-Blanco I, Millan AM, Castellví I, Maiz-Alonso O, Juan A, Álvarez Reyes F, Martín-Varillas JL, Vegas-Revenga N, Blanco R, González-Gay MA. Rituximab in Rheumatoid Arthritis with Interstitial Lung Disease: A Multicenter Study of 32 Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/rituximab-in-rheumatoid-arthritis-with-interstitial-lung-disease-a-multicenter-study-of-32-patients/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rituximab-in-rheumatoid-arthritis-with-interstitial-lung-disease-a-multicenter-study-of-32-patients/