Background Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is commonly found in elderly patients with RA. There have been several case reports regarding the adverse effect of anti-TNF therapy in RA-ILD patients. However, to date there have been relatively few studies including large number of patients.
Objectives The purpose of our study was to identify the mortality rate and the causes of death in RA-ILD patients treated with anti-tumor necrosis factor (anti-TNF).
Methods We retrospectively reviewed the medical records of RA-ILD patients in a tertiary care medical center between 1995 and 2011. First, we searched for RA-ILD patients who were treated with anti-TNF agent and analyzed their clinical characteristics and the causes of death. Survival rate according to age at the initiation of anti-TNF therapy was also analyzed. To determine the effect of anti-TNF therapy on mortality, the patients were divided into two groups, i.e. the DMARDs (disease modifying antirheumatic drug) group patients who were only treated with DMARDs and the anti-TNF group patients who were treated with anti-TNF agent at any point in time. We compared the clinical characteristics and survival rate between the two groups.
Results Twenty four RA-ILD patients treated with anti-TNF agent were analyzed. All six deaths occurred within 14 months after treatment initiation, and the causes of their deaths included acute exacerbation of ILD, pneumonia, septic shock, and diffuse alveolar hemorrhage. Survival rate of the patients who started anti-TNF therapy at under 70 years of age was higher than that of patients 70 years of age or older. In a total 100 RA-ILD patients of our study cohort, the DMARDs group and the anti-TNF group were composed of 76 and 24 patients, respectively. There were 13 and 6 deaths, respectively, in the DMARDs group and the anti-TNF group (17% vs. 25%). The all-cause mortality was 25 deaths/1,000 person years in the DMARDs group compared with 28 deaths/1,000 person years in the anti-TNF group. The survival rate was not significantly different between the two groups (p = 0.935).
Conclusions Although the mortality rate of the patients who underwent anti-TNF therapy was not different from that of patients treated only with DMARDs, anti-TNF agent should be used with caution in older RA-ILD patients.
Disclosure of Interest: None Declared