Background/Purpose: Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis (RA) that may be related to the inflammatory process itself, to infectious complications, and/or to the therapy. Biological disease‐modifying antirheumatic drugs (bDMARD) have dramatically improved the outcome of RA, but an increasing number of reports have described  the potential lung toxicity of this group of drugs.

Methods: Retrospective cohort study using data from RA patients beneficiaries of the “Ley Ricarte Soto program”, at the Hospital Clínico Universidad de Chile, was conducted to assess ILD prevalence and exacerbations , among users of abatacept (ABA), rituximab (RTX), and anti-TNFα agents. Clinical findings and laboratory data were collected from medical records. The presence or progression of ILD on HRCT was evaluated by a rheumatologist, a pneumonologist and a radiologists who have expertise in assessing ILD, all part of the Rheumatic Lung Group at our Hospital.

Results: 126 RA patients were included; 85% female, mean (SD) age 55 (13.4) years, mean disease duration 11 (8.7 years). RA was seropositive in 108 patients (85.7%). DAS28 ESR was 6.1 (1.2) previously to initiate bDMARDs. A total of 30 patients (23.8%) had been previously diagnosed with ILD, most common patterns on HRCT were UIP (n=10[33%]) and bronchiolar abnormalities (n=4[13.3%]). Patients with as compared to without ILD at baseline were more frequently males (53 vs 15%, p < 0.05), had an older age (62.6 + 11.9 vs 55 + 13.4, p < 0.005), a higher positivity of anti-CCP (73 vs 47.6% p < 0.005) and a more frequent history of smoking (43 vs 21%, p < 0.005). The patients with a history of ILD were also, significantly more likely to receive ABA (n=24 [82.8] % versus n=35 [36.1%] without ILD; p < 0.001) and significantly less likely to receive anti-TNF therapy (n=3 [10.3%] versus n=57 [58.7 %] without ILD; p < 0.001). Only 6 patients received RTX, two of them with history of ILD. All patients with RA-associated ILD remained stable at 28 month follow-up. In the group of patients without a history of ILD, only one developed an organizing pneumonia that responded well to corticosteroids and was not related to the biological therapy.

Conclusion: Our data show that, in a real-world setting, there were no significant differences in the risk of complications between patients with or without a baseline history of ILD receiving different biologic agents. In our Cohort, bDMARDs were not associated with new ILD either. These data may be affected by the short follow-up window and the preference for the use of ABA, over anti-TNFα agents, as initial biological therapy in RA-ILD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/safety-of-biological-dmard-in-patients-with-interstitial-lung-disease-from-a-chilean-cohort-of-patients-with-rheumatoid-arthritis/